1. Acknowledgements
The Project CHANCE committee gratefully acknowledges the
contributions of those who made this possible. Mahmoud Moukalled
designed and programmed our database, and then graciously made
changes and updates after every event. We’re also especially grateful
to the staff and patients at Benton Plaza and Benton County Health
Center for their participation in this project.
APhA-ASP Project CHANCE with the
Community Health Centers of Benton and Linn County:
A Medication Reconciliation Project
Levine P, Kong B, Van Devender EA, Leinbach M, Moukalled K, DeLander G and Ramirez S
Oregon State University, College of Pharmacy, Corvallis, OR 97331
Introduction
Community Health Centers of Benton and Linn Counties
(CHCBLC), a federally qualified 340B entity, served more than
6000 patients in 2007. We have worked together to implement a
medication reconciliation project that is intended to improve
wellness by decreasing medication errors, duplication or adverse
interactions. Medication reconciliation services have been
demonstrated to play an important role in reducing medical
errors, and pharmacists or pharmacy students can have a direct
impact in this area.
CHCBLC has four locations in Corvallis and surrounding rural
Oregon communities. CHCBLC offers services to anyone, with
or without health insurance. Costs are established by an income
based sliding-fee scale. Patients can receive prescriptions
through an outpatient pharmacy contracted to provide
medications through the 340B program. Many patients receive
all medical care through CHCBLC, but it is common for
patients to have other providers, use multiple pharmacies and
fail to volunteer information regarding over-the-counter and
alternative medicine purchases.
Results
During review of medical charts, students were able to identify
cases of drug therapy duplication and confusing or misleading
directions. These instances were brought to the attention of the
appropriate parties. Student pharmacists have also been able to
answer questions from patients about medications and discuss
dosing schedules and ways to improve adherence and reduce
undesirable side effects.
The project ran in to some challenges in implementation.
Development of the database was graciously done by a
programmer who donated his time to the project. Technical
incompatibilities caused some roadblocks that were overcome
with ingenuity and perseverance. Patients were also reluctant in
some cases to interact with students while waiting for medical
appointments. Survey return rates were low. As we continue the
project beyond the first year, we anticipate increased data and
the ability to improve our project based on concrete results.
Discussion
This project has presented both challenges and learning
opportunities. Students have benefitted from interaction with
patients, especially those with complicated regimens. Many patients
seen by the students take 15-20 medications routinely and benefit
from clearer instructions as to dose and timing of administration.
The use of our weekly calendars and medication cards can be used
as a tool to increase medication adherence for this population. We
were able to provide opportunities to the entire student body, and
incorporate 1st and 2nd year students as part of their Introductory
Pharmacy Practice Experience. The project has taught students to
recognize drugs and drug classes, pharmacological interactions and
errors, patient-specific obstacles, and enhance their relationships
with other health professionals. This experience exposed students to
the significance of medication therapy management (MTM)
services. Overall, our project has contributed to the enhancement of
the profession of pharmacy by expanding the role of pharmacists in
the healthcare system.
Future Plans
This project will be established as a permanent patient care
outreach committee within the College of Pharmacy. The project is
highly portable and ideal for including in outreach events for the
community. Customized medication lists and schedules will be
provided to patients as part of an ‘ask the expert’ or ‘brown bag’
outreach at health fairs, as well as continued targeted outreach with
underserved populations.
Prescription and non-prescription medications (supplements,
vitamins, etc.) are included, as well as patient information.
Customized dosing schedules are also provided. A variety of
colored stickers and labels are used to clarify dosing
instructions and improve adherence where appropriate. Student
pharmacists discuss regimens with patients as appropriate and
document any duplications or potential interactions. Patients
and providers were surveyed throughout the project.
Assessment forms were developed for each population to
measure the impact of the project and improve outcomes.
Methods
A database was developed that allows
students to enter and record a patient’s
medication information, either by
interviewing the patient or by reviewing
their medical chart. The project has a
laptop and printer as well as printed
materials and is very portable. Students
have provided services at several venues
including federally qualified health clinics
and a support program for patients with
mental health conditions. At events, a
customized medication list, wallet-sized
for convenient carrying, is printed and
provided to the patient.
For patients on complicated regimens, or
if needed for better readability, a full page size medication
record is provided. When the patient is not present, the
medication record is attached to the medical chart for
presentation to the patient at the next visit. When medication
regimens change, a new card may be printed for the patient.
Figure 1. Sample Medication Card
Figure 2. Sample Dosing Calendar.
Figure 3. Database Editor