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Communication Gap Exists Regarding Patients’ Discontinued Medications

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Study shows patients continue to receive medications at pharmacies despite being discontinued by physicians

Each year, physicians discontinue more than 85,000 medications; however, this information is not always shared with the pharmacists involved. Identified by researchers from Brigham and Women’s Hospital (BWH) and Harvard Vanguard Medical Associates, this communication gap represents an important patient safety concern, as it allows discontinued medications to be dispensed at pharmacies.

“This is a novel patient safety issue that has not been measured previously,” explained Thomas Sequist, MD, MPH, a physician at BWH and Harvard Vanguard, and senior author of this study.

For the study, recently published in the Annals of Internal Medicine, researchers used electronic medical records to analyze 1218 medications that were discontinued throughout 2009. Then a sample of more than 400 medical charts were examined for any adverse events that may have been a result of the patient continuing to take a discontinued medication. The study results showed that 1.5% of discontinued medications continue to be refilled by the pharmacy. Of those filled prescriptions, potential harm as a result of the medications occurred in 12% of the cases. Patient health risks ranged from severe issues such as low blood pressure and possible allergic reactions, to less serious consequences such as lightheadedness or nausea.

Electronic medical records now allow prescriptions to be easily transmitted to pharmacies with just the click of a mouse. When discontinued, these same prescriptions can be removed from medication lists in the physician’s office with a similar click. Now, this study reveals that there is little feedback to either physician offices or retail pharmacies regarding a patient’s continuation or termination of prescriptions. Many physicians may incorrectly assume that discontinuing a medication in the patient’s electronic health record will automatically transmit the information to the pharmacy, as it is when a new prescription is transmitted.

“The implementation of electronic health records have offered a clear opportunity to track when a clinician discontinues a medication, but now there needs to be a process that helps discontinued orders be transmitted electronically to the retail pharmacy,” explained Adrienne Allen, MD, MPH, lead author of this study.

Source: Brigham and Women’s Hospital.