Assessing medication self-management challenges and self-efficacy during emergency department medication reconciliation: An evidence-based quality improvement project

Authors

Mitchel Erickson, University of California San FranciscoFollow
Jyu-Lin ChenFollow
Yoonmee Joo, University of California San FranciscoFollow
Stephanie Rogers, University of California San FranciscoFollow
Thomas Hoffman, University of California San FranciscoFollow
Claire Bainbridge, University of California San FranciscoFollow

Author ORCID Identifier

0000-0003-3778-8367

Abstract

Abstract

Background

Older adult patients (≥65) accessing emergency departments (ED) represent a significant demographic. Recidivism secondary to adverse drug events (ADE) ranges between 6-24% and levels of prescribed medication non-adherence is common among older adults. The ED pharmacist medication reconciliation workflow may mitigate self-management challenges in real time and reduce medication-related harm while potentially impacting recidivism, medication adherence, and patient self-efficacy. The purposes of this evidence-based project were to (1) evaluate the impact of a modified Medication Management for Deficiencies in the Elderly (MedMalDE) intervention on Self-Efficacy for Appropriate Medication Use (SEAMS) and 30-day return to care and (2) identify factors associated with medication self-management challenges (MedMalDE) in the participating institution.

Methods

As part of an evidence-based quality improvement (QI) effort to build an accredited geriatric emergency department (GED) and meet State legislated acute care medication history requirements, a new medication reconciliation workflow was deployed. To assess the intervention’s impact on self-efficacy in a pre/post design, 21 older adult patient’s underwent SEAMS assessment at two time points: the intervention and 7-14 days post-discharge from the emergency department. Baseline data and medication self-management challenges for an ED convenience sample of 167 older adult patients completed the MedMalDE. Descriptive statistics and a logistic regression model were used to evaluate the impact of the intervention and factors associated with medication management deficiencies. Wilcoxon Signed Rank was used for pre/post SEAMS score change.

Results

The self-efficacy (SEAMS) scores of 21-patients participating in the intervention were significantly improved from 19.88 to 21 (p=0.0077, p10%, included lack of knowledge regarding medication names, ease of opening or manipulating medications, ease of swallowing medications, and affordability. MedMalDE total scores were significantly associated with female gender (OR=2.0, 95%CI=1.14-3.51, p=0.016), and the functional (ability) subscale was associated with female gender (OR=1.88, 95%CI=1.03-3.41, p=0.011) and patient as the informant (OR=0.49, 95%CI=0.27-0.89, p=0.019).

Conclusion

Integrating a modified MedMalDE into medication reconciliation can identify common patient medication self-management challenges in real-time, guiding pharmacist’s interventions and potentially reducing medication-related harm. Individualized assessment improves self-efficacy while ensuring the health system has a reliable and accurate medication history at times of transition.

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.

Recommended Citation

Erickson, Mitchel; Chen, Jyu-Lin; Joo, Yoonmee; Rogers, Stephanie; Hoffman, Thomas; and Bainbridge, Claire (2023) "Assessing medication self-management challenges and self-efficacy during emergency department medication reconciliation: An evidence-based quality improvement project," Journal of Geriatric Emergency Medicine: Vol. 4: Iss. 3, Article 6.
DOI: https://doi.org/10.17294/2694-4715.1069
Available at: https://institutionalrepository.aah.org/jgem/vol4/iss3/6