Smart Medication Reconciliation and Problem Lists

Last week, I spent a few days in California when both my parents ended up in the hospital with different issues.   They're home, settled and doing well at this point.



Just as when I first wrote about experiencing healthcare with my family, there are important lessons to learn about this trip.



As we strive to achieve meaningful use and create health information exchange in the US, the need for smart viagra cialis online pharmacy pharmacy is critical.



Our current national systems do a good job of retrieving a history of medications that were filled or reimbursed, but they do not do a good job of identifying those medications which are active - that is left to the patient or their family.   What do you do if the patient is unable to answer, the family is unavailable, or the patient/family does not really know what medications are current.



My family was able to provide history such as "the green capsules, or the pink pill", which were insufficient to achieve accurate medication lists.



Similarly, it can be challenging to retrieve an active problem list from claims data, which is often inaccurate or imprecise.



The result is that my parents received unnecessary medications as well as did not receive necessary ones.



The hospital focused on the acute inpatient problems without attending to the more chronic outpatient ones.



How do we solve this?



1.  Ensure every patient has a personal health record, an electronic medical home with an updated medication list and problem list.



2.  Implement novel decision support that infers active medications by examining recent refill history and active problems by examining available data sources such as lab history, recent diagnostic studies which imply active diagnoses i.e. a recent high hemoglobin A1c in a patient on insulin implies diabetes.  Here's a design from AnvitaHealth, a decision support services provider for which I serve as a Board member.



3.  At its very simplest, carry a wallet card with an active medication list and problem list.



While in California, I isolated every medication in the house, current and historical.   I documented active medications, active problems and the relationship between the medications and the problems.   I reviewed the resulting lists will all family members (with their consent).   My parents will ensure all their clinicians update their records to reflect this accurate information.   They will carry with them to any future hospitalizations.    I disposed of historical medications (safely) to prevent any future confusion.   I isolated medications for each person so there would be no accidental taking of medications intended for other people.



Admittedly as a clinician, I have the training that enables me to do this.



For families without clinicians, create a shopping bag of medications and take it to a primary care visit for a family medication reconciliation exercise or ask for the help of health coach.



As we build electronic systems, the outpatient to inpatient transition will  become more seamless and accurate, but during this time of evolving connectivity and less than perfect use of electronic health records, I encourage everyone to reconcile their medications and problems, get them into a PHR, and share them widely with family members and caregivers.

Counterknowledge

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(Damian Thompson in ‘Counterknowledge,’ p. 93 Landmark)

Female mood disorders gain credibility

It is interesting to note that these researchers are using a holistic approach to the study of women and depression and that the impact and magnitude of depression can be gender specific.


Chris Zdeb
CanWest News Service


Saturday, January 12, 2008


Women's so-called moodiness is often jokingly attributed to "that time of the month" or menopause, but mood disorders are a serious and pervasive cheap viagra problem.

That so little is known about women and depression probably stems from the fact that most research in the area involves male rats.

Women are up to three times more likely than men to suffer from major depressive disorder and it's time for gender-specific research to help understand why, say two nursing professors and women's cheap cialis experts from the University of Alberta.

"Historically, there has been a tendency to minimize women's depression and explain it away as women's troubles, but it's actually not that simple," says Gerri Lasiuk.

"There is growing evidence that estrogrens have powerful effects beyond their role in reproduction, that they play a critical role in mood disorders in women, and that opens up new avenues of research into the underlying biological mechanism and treatment of depression," says Kathy Hegadoren.

Estrogen is used to treat various mood disturbances in women such as perimenopausal, post-menopausal and postpartum depression, but the results are difficult to interpret because researchers are only beginning to recognize the complex interactions among estrogens, serotonin and mood.

"We can't sort of break people up into simple components and say because of the level of this hormone in the brain you have these symptoms or you have these life difficulties," Hegadoren says. "We have to look at people holistically and look at how these things interact in an individual's life.

The women's study recognizes that depression is the result of more than just the interactions of hormones and neurotransmitters: there is a strong association between depression and stressful events in a woman's life.

Women live with a higher degree of violence in their lives than men do, a stressor which may precipitate depression in women that are vulnerable, especially the first couple of episodes, Hegadoren adds. In some women, it becomes a learned response that follows every stressful event in their lives.

"What is a bit frustrating and maybe a bit surprising, is that given what we know about sex and gender differences, we are so slow as researchers and service providers to begin integrating that knowledge into our work," Hegadoren says.

Especially when there is a growing recognition of the fact that if you look after women and their health, the health of their families improves as well.

Hegadoren and Lasiuk have invited a multi-disciplinary team of other researchers, service providers and policy-makers from across Canada to come together and set up an integrated research plan around women's health and interperseronal violence such as childhood sexual physical abuse, emotional abuse, neglect, intimate partner violence and sexual assault.

A better understanding of the issue would help decrease the number and duration of depression symptoms across women's lives, Hegadoren says.

Not only drug therapy, but other types of interventions drawing on the relationship between exercise and serotonin and the quality and amount of light and serotonin would be investigated, adds Lasiuk.

It would give hope to women who suffer from depression that there is something more that can be done to help them, Lasiuk says.

Studies show 20 to 25 per cent of women will suffer with depression at some point in their lives, but only a third seek treatment because of the stigma that still exists around mental illness of any kind.

The researchers' call for better research into the link between women's hormones and mood disorders, based on a review of previous studies, appears in a paper published in the October issue of Biological Research for Nursing.

czdebthejournal.canwest.com

(Edmonton Journal)

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