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      High Prevalence of Medication Discrepancies Between Home Health Referrals and Centers for Medicare and Medicaid Services Home Health Certification and Plan of Care and Their Potential to Affect Safety of Vulnerable Elderly Adults

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          Abstract

          To describe the prevalence of discrepancies between medication lists that referring providers and home healthcare (HH) nurses create.

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          Most cited references13

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          A review of diabetes treatment adherence and the association with clinical and economic outcomes.

          The benefits of drug therapy to diabetic patients in terms of glycemic control, microvascular complications, cardiovascular event risk, mortality, and quality of life have been well established by clinical trial data. However, it has been a challenge to quantify the relationship between adherence and outcomes such as glycemic control, disease-related events, hospitalizations, cost, and quality of life. This article provides a comprehensive summary of empirical studies that examine the associations between adherence and glycemic control, health care utilization, quality of life, and mortality in patients with diabetes. It is intended to provide a framework for researchers interested in conducting studies to improve their understanding of the value of medication adherence for patients with diabetes. Relevant published articles were identified through searches of the National Center for Biotechnology PubMed database. Medical subject heading (MESH) terms diabetes mellitus, hypoglycemic agents, and insulin, were each combined with the MESH term medication adherence and with the subheadings economics, prevention and control, psychology, statistics and numerical data, therapy, adverse effects, therapeutic use, and administration and dosage, where available. Studies were included if they met the following criteria: (1) analyzed empirical data on some measure of patient adherence to diabetes pharmacotherapy; (2) described methods for measuring patient adherence; (3) evaluated economic, clinical, or humanistic outcomes related to diabetes; and (4) had as a goal of the research to evaluate the link between patient adherence and outcomes (as a primary or secondary objective). The data from the articles meeting these criteria were then abstracted, including mention of the specific interventions being compared, specific methods for measuring adherence, outcomes compared between adherent and nonadherent patients and how these outcomes were measured, and information on variables that were adjusted for in predictive and causal multivariable models. A total of 37 articles that met all 4 criteria in this review underwent data extraction. Of these studies, 22 (59%) used objective measures to assess adherence, with 1 study using pill counts to assess adherence and 21 using either pharmacy claims or similar refill records to assess refill behavior. The remaining 15 (41%) studies used a wide variety of subjective patient-reported adherence assessments. The majority (13/23 [57%]) of the glycemic control studies reported that improved adherence was associated with better glycemic control. The ability to draw a distinction between adherence and glycemic control tended to occur more frequently [7/9 (78%)] among studies that characterized adherence in terms of prescription refills compared with studies that used various constructs for patient-reported adherence measures. Based on the literature, better adherence was found to be associated with improved glycemic control and decreased health care resource utilization. There was no consistent association between improved adherence and decreased health care costs. Little data were available on the association between adherence and quality of life. Copyright © 2011 Elsevier HS Journals, Inc. Published by EM Inc USA. All rights reserved.
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            Medication reconciliation during transitions of care as a patient safety strategy: a systematic review.

            Medication reconciliation identifies and resolves unintentional discrepancies between patients' medication lists across transitions in care. The purpose of this review is to summarize evidence about the effectiveness of hospital-based medication reconciliation interventions. Searches encompassed MEDLINE through November 2012 and EMBASE and the Cochrane Central Register of Controlled Trials through July 2012. Eligible studies evaluated the effects of hospital-based medication reconciliation on unintentional discrepancies with nontrivial risks for harm to patients or 30-day postdischarge emergency department visits and readmission. Two reviewers evaluated study eligibility, abstracted data, and assessed study quality. Eighteen studies evaluating 20 interventions met the selection criteria. Pharmacists performed medication reconciliation in 17 of the 20 interventions. Most unintentional discrepancies identified had no clinical significance. Medication reconciliation alone probably does not reduce postdischarge hospital utilization but may do so when bundled with interventions aimed at improving care transitions.
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              Medication adherence leads to lower health care use and costs despite increased drug spending.

              Researchers have routinely found that improved medication adherence--getting people to take medicine prescribed for them--is associated with greatly reduced total health care use and costs. But previous studies do not provide strong evidence of a causal link. This article employs a more robust methodology to examine the relationship. Our results indicate that although improved medication adherence by people with four chronic vascular diseases increased pharmacy costs, it also produced substantial medical savings as a result of reductions in hospitalization and emergency department use. Our findings indicate that programs to improve medication adherence are worth consideration by insurers, government payers, and patients, as long as intervention costs do not exceed the estimated health care cost savings.
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                Author and article information

                Journal
                Journal of the American Geriatrics Society
                J Am Geriatr Soc
                Wiley
                00028614
                November 2016
                November 2016
                September 27 2016
                : 64
                : 11
                : e166-e170
                Affiliations
                [1 ]Geriatric Research Education and Clinical Center; James J. Peters Bronx Veterans Affairs Medical Center; Bronx New York
                [2 ]Hartford Institute for Geriatric Nursing; College of Nursing; New York University; New York New York
                [3 ]Informatics Decision-Enhancement and Analytic Sciences; George E. Wahlen Veterans Affairs Medical Center; Salt Lake City Utah
                [4 ]Department of Biomedical Informatics; University of Utah; Salt Lake City Utah
                [5 ]MITRE Corporation; Bedford Massachusetts
                [6 ]Brandeis University; Waltham Massachusetts
                [7 ]Geriatric Research Education and Clinical Center; George E. Wahlen Veterans Affairs Medical Center; Salt Lake City Utah
                [8 ]College of Social Work; University of Utah; Salt Lake City Utah
                [9 ]Department of Geriatrics; University of Utah; Salt Lake City Utah
                Article
                10.1111/jgs.14457
                7293876
                27673753
                7aa58365-deba-48bc-bd5a-1582bc39ec20
                © 2016

                http://doi.wiley.com/10.1002/tdm_license_1.1


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