Medication Reconciliation and Hypertension Control

Stephen D. Persell*, Stacy Cooper Bailey, Joyce Tang, Terry C. Davis, Michael S. Wolf

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

32 Scopus citations

Abstract

Background: Discrepancies between the medical record and patient medication list are common. The relationship of discrepancies to chronic disease control has not been established. Methods: To determine the frequency and type of antihypertensive medication discrepancies between patient-named antihypertensive medications and the medical record, we performed a cross-sectional study of 315 adults with medically treated hypertension from 6 safety-net clinics in 3 states. We determined the association between medication discrepancies and uncontrolled blood pressure (≥140/90 mm Hg or ≥130/80 mm Hg if diabetes) using multivariate logistic regression models. Results: Discrepancies were present for 75.2% of patients; 25.7% of patients could not provide the name of any antihypertensive medication they took; 49.5% could name 1 or more antihypertensive medications but had discrepancies between patient-reported antihypertensive medications and those listed in the medical record. Both patients who were unable to name any of their antihypertensive medications and patients with discrepancies between patient-named medications and the medical record were significantly more likely to have uncontrolled blood pressure than patients who named the same medications as the medical record in adjusted analyses, adjusted risk ratios 1.66 (95% confidence interval, 1.31-2.10) and 1.51 (95% confidence interval, 1.11-2.07), respectively. Twelve percent of patients reporting medications took antihypertensive medication that altered potassium metabolism that was not in their medical record. Conclusions: Among patients at safety-net clinics, inability to name one's antihypertensive medications and discrepancies between patient-reported medications and the medical record were very common. Both were strongly associated with inadequate hypertension control. Performing medication reconciliation at the point of care may be an important way to identify patients at high risk for inadequate disease control or safety problems.

Original languageEnglish (US)
Pages (from-to)182.e9-182.e15
JournalAmerican Journal of Medicine
Volume123
Issue number2
DOIs
StatePublished - Feb 2010

Funding

Conflict of Interest: Dr. Wolf has received unrestricted research grant funds from Target Corporation and from Pfizer Corporation . No other authors have conflicts of interest. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. Funding: This work was supported by research grants from the Michigan Department of Community Health , Pfizer Pharmaceuticals, Inc. , and support from the Health Literacy and Learning Program at Northwestern University and Department of Medicine-Pediatrics, Louisiana State University Health Sciences Center at Shreveport. Dr. Persell was supported by career development award 1 K08 HS015647-01 from the Agency for Healthcare Research and Quality.

Keywords

  • Ambulatory care
  • Blood pressure
  • Errors
  • Health literacy
  • Hypertension
  • Medication discrepancies
  • Medication reconciliation
  • Outpatient

ASJC Scopus subject areas

  • General Medicine

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