Preventing Medication Errors in Ambulatory Care: The Importance of Establishing Regimen Concordance
AGENCY FOR HEALTHCARE RESEARCH AND QUALITY ROCKVILLE MD
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For patients with atrial fibrillation and other conditions associated with a risk of thromboembolic complications, anticoagulant care is the cornerstone of treatment. While warfarin therapy can markedly reduce the rate of thromboembolic events, not all treated patients receive the full benefits of warfarin therapy. Studies have demonstrated that, among treated patients, nearly one-half have international normalized ratios INRs outside the therapeutic range, placing them at risk for serious, preventable complications such as stroke if under-anticoagulatedand bleeding if over-anticoagulated.Among older patients, oral anticoagulants have been shown to be associated with as many as 10 percent of preventable adverse drug events. Drugs that have a narrow therapeutic window and require long-term management with frequent dose adjustments, such as oral anticoagulants, require intensive communication. Effective communication regarding medications has been shown to promote medication adherence in the treatment of chronic diseases and can help prevent medication-related errors. Numerous studies have documented the prevalence and consequences of patient non-adherence e.g., pill-taking in the chronic disease context including anticoagulant care. Much less is known about rates of medication miscommunication, manifested as regimen discordance between patient and provider or the contribution of regimen discordance to chronic disease outcomes independent of adherence. While studies have demonstrated tremendous variability in the means used by clinicians to counsel their patients about medications there is little empirical evidence to support one practice over another. We used the model of anticoagulant care to examine the extent to which regimen discordance between patient and provider contributes to unsafe medication management.
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