Primary care is healthcare that is provided in the community. In the primary care setting patients can go for treatment of newly diagnosed conditions and for treatment and prevention of chronic disease. It often serves a coordinating function for all of a patient's care and is pivotal in ensuring continuity of care. In Ontario, primary care is offered in a wide range of practice settings, including individual practitioners' offices, community health centres, family health teams, and other team-based practices. Similarly, many different providers may be involved in delivering primary care, including family physicians, nurse practitioners, nurses, pharmacists, dietitians, and social workers.
An important component of providing and coordinating care for patients involves managing their medications. To do this effectively (i.e., to optimize benefit and minimize harm), both providers and patients must play active roles. For any given patient, each provider should be aware of all medications prescribed by other providers, as well as medications that the patient has initiated, including alternative therapies that may have pharmacologic effects. Providers should also clarify how a patient is actually using each product, which may differ from the prescribed use (given that patients often do not fully adhere to instructions for their medications). In addition, the individual who is responsible for managing the patient's medications, either the patient or a caregiver, must be educated about each medication in the regimen and the importance of communicating about all medications to every member of the healthcare team.
Unfortunately, managing patients' medications can be particularly challenging in the primary care sector. Primary care providers often do not have the necessary tools and resources to easily generate a list of a patient's medications. Any medication lists that do reside with primary care providers are often incomplete and may not reflect how patients are actually taking their medications in their home environments.1-3 Many primary care providers do not have enough time to complete thorough medication histories, because they have only periodic or infrequent contact with the patient and do not receive complete information about medications from other healthcare providers.4-6 In addition, patients may be unaware of the importance of conveying information about their medications to various healthcare providers, they may have limited health literacy, they may be unable to accurately communicate information about their medications, or they may assume that all of their primary care providers have access to a complete medication list. One unintended, though often preventable, consequence of incomplete medication information is an adverse drug event.7-11
Medication reconciliation (also known as "MedRec") is a patient safety intervention that was introduced to improve communication about patients' medication information as they transition through the healthcare system. It is targeted at both the patient and the patient's healthcare providers and is designed to help prevent adverse drug events. MedRec takes into account all of the medications that a patient is taking and ensures that this information is communicated consistently and accurately during transitions of care.12 In Ontario and elsewhere, MedRec is already well defined in other sectors of care (e.g., acute care and long-term care) but is less well defined for primary care. This resource document is intended to advance the practice of MedRec in primary care in Ontario by providing implementation strategies, identifying the levers and barriers that already exist, suggesting approaches to close the gaps among various primary care providers, and providing strategies for measuring performance.
To assist in achieving the main goal of MedRec in primary care (i.e. the prevention of adverse drug events), providers should take the following actions,:
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