Primary Care MedRec Guide

Measurement in quality improvement offers the ability to determine current performance (or baseline), set goals for future performance, and monitor the effects of changes as they are made. Successful measurement is a cornerstone of successful improvement. Measurement does not have to be difficult or time-consuming. The key is to pick the right measures that allow you to see results quickly and are able to adapt their interventions accordingly, putting less strain on resources and more focus on outcomes. For more information on effective measurement for quality improvement initiatives refer to Measurement for Quality Improvement.

The measures that are selected should ensure that the outcome of the intervention is being measured, in addition to ensuring that the process implemented is functioning as intended.

Based on the current infrastructure and documentation practices in the primary care setting easily extracting the data necessary (e.g., a list of patients who are eligible for MedRec or have had MedRec completed) for more meaningful measures may be quite challenging.

Counts of the number of patients that have participated in various aspects of the MedRec process might be the most straightforward way to measure this multi-faceted intervention with limited resource supports. It can provide a sense of the gains that are being made with implementing and spreading this intervention throughout the practice setting.

Ideally, if better resources were available then measures that provided more context on the how the process is functioning and if it is achieving the desired outcome would be collected.

For example:

In order for this measure to be meaningful clear definitions of the numerator and denominator are necessary. Depending on the practice setting the definitions could vary making it difficult to compare one practice setting to another.

For example:

Numerator: # of patient charts with a reconciled list documented

How to determine if a reconciled list was documented?

• Does it require the provider to specifically document 'MedRec completed'?
• Is it based on a chart review and if a reconciled list can easily be identified?

Denominator: Total # of eligible patients

What constitutes an 'eligible patient'?

• Patients on X number of medications
• Patients who have a diagnosis of an Ambulatory Care Sensitive Condition
• Patients who have been discharged from hospital 7 days ago

The measures below are potential measures, relating to the goals of MedRec that could be used to determine if the MedRec processes implemented are functioning as intended and whether or not the desired outcome of the processes is being achieved.

GOAL - Aim to have a complete and accurate list of the medications a patient is taking to optimize safe, effective and appropriate drug therapy.

Process Measure(s)

Corresponding Change Ideas

• Use screening tools to focus MedRec efforts towards high-risk patients
• Complete MedRec on all patients discharged from hospital within one week of discharge
• Print medication lists from EMR or patient's chart for patients to review in waiting room before their appointment to self-identify discrepancies
• Develop form or specific section in chart to document BPMH and update reconciled list

GOAL - Encourage/empower patients to become more involved in managing their medications by providing them with the necessary information and resources to do so.

Process Measure(s)

Corresponding Change Ideas

• Have receptionist call patients in advance of their appointment to remind them to bring with them their med lists / meds
• Encourage eligible patients to have a MedsCheck completed by their community pharmacy
• Print medication lists from EMR or patient's chart for patients' to review in waiting room before their appointment to self-identify discrepancies
• Provide up to date medication lists to patients
• Provide patients with tools to record and update their medications lists
• Use teach-back method to verify patients' understanding of their medication regimen

GOAL - Strive to accurately communicate about a patient's medications amongst the patient's healthcare team

Process Measure(s)

Corresponding Change Ideas

• Provide community pharmacists with initial reconciled list
• Liaise with community pharmacist to complete MedsCheck
• To develop standard referral form that has current medication list section

Health Quality Ontario's Primary Care Performance Measurement Framework contains the following MedRec related measures:

• Percentage of patients who report that, in the past 12 months, they had a review and discussion with their primary care provider of prescription medications they are using
• Percentage of patients how report that, in the past 12 months, a healthcare provider explained the potential side effects of any medication that was prescribed
• Percentage patients who, in the past two years, were not sure what a new prescription medication was for or when or how to take it

For technical information on these measures refer to the Technical Appendices: Report of the Steering Committee for the Ontario Primary Care Performance Measurement Initiative: Phase One.