Primary Care MedRec Guide

Benefits

• Interview can assist with determining actual medication use by the patient and accuracy of information from other sources of information
• Can provide an opportunity to assesses the patient's / caregiver's understanding of medication regimen

Limitations

• Information may be based solely on patient / caregiver recall
• Focus on determining how the patient actually uses their medication; not just how the medications were prescribed

Benefits

• Easily accessible
• May include indications for medications

Limitations

• May not include nonprescription medications, vitamins, natural products etc.
• May not include medications prescribed by other practitioners (e.g., specialists, dentists etc.)
• May not reflect actual medication use by patient
• May only be as current as last visit with patient

Benefits

• May include all the medications a patient is taking (i.e., those prescribed by multiple prescribers and dispensed at multiple pharmacies)

Limitations

• Will likely only contain information that the patient has remembered to record or deemed appropriate to record
• May not reflect recent changes
• May not include nonprescription medications, vitamins, natural products etc.
• May be difficult to distinguish whether the list reflects actual use or prescribed use

• Determine who wrote the list
• Confirm the date it was last updated
• Inquire if the directions written represent how the medications were prescribed or how the patient actually takes the medications
• Determine if the patient is taking medications that are not recorded on the list

Benefits

• Usually includes complete medication information (medication name, dose, route, frequency and prescriber information)
• Clinician is able to assess contents of the vial / package
• Patient can visualize the medication which may cue their memory on how they actually take the medication

Limitations

• Information on the label may only reflect prescribed use and not actual use by the patient

• Check the patient's name and date on the vial
• Open the vials to ensure the medication inside the vial matches the label
• Determine if any changes have been made to the patient's medications since the vials were last dispensed
• Ask the patient how they are taking their medications and compare this to the directions on the vial
• Be aware that directions on medication vials may not accurately reflect medications that are: taken on "as needed" basis, have fluctuating doses (e.g., warfarin, prednisone)

Benefits

• Usually includes complete medication information (e.g. medication name, dose, route, frequency and prescriber information)
• Clinician is able to assess contents of the blister pack
• Patient can visualize the medication which may cue their memory on how they actually take the medication

Limitations

• Information on the label may only reflect prescribed use and not actual use by the patient
• May not contain all the medications a patient is taking

• Check the patient's name and date on the blister pack
• Determine if any changes have been made to the patient's medications since the blister pack was last filled
• Ask the patient how they are taking their medication and compare this to the directions on the bister pack
• Ask about medications that cannot fit inside the pack (e.g. inhalers, patches, eye/ear drips, refrigerated medications, injections, liquid medications)
• Be aware the blister pack may not include medications that are: taken on an "as needed' basis, have fluctuating doses (e.g., warfarin, prednisone), nonprescription medications, vitamins, natural products etc.

Benefits

• Usually includes complete medication details (i.e., medication name, date, dose, route, frequency and prescriber information)
• Able to retrieve one year of past medication information or longer

Limitations

• Only reflects medications dispensed from that particular community pharmacy; if the patient goes to multiple pharmacies, a single list containing all medications from all pharmacies may not be available
• May not include nonprescription medications, vitamins, natural products etc.
• May only reflect prescribed directions and not actual medication use by patient

• Determine if the patient frequents more than one pharmacy
• Confirm actual medication use with the patient
• Confirm with the patient if they are taking any other medications (e.g., medications dispensed from other pharmacies, samples from prescribers, nonprescription medications, vitamins, natural products etc.)
• Confirm allergies that the community pharmacy has on record

Benefits

• Should include all the medications a patient is taking including prescription and nonprescription medications, vitamins, natural products etc.
• Should also include medications dispensed at pharmacies other than the pharmacy performing the MedsCheck
• Should include complete medication details (i.e., name, dose, route and frequency for each medication)

Limitations

• Information is only as accurate as the day of the review
• Appearance / format can vary from pharmacy to pharmacy

• Check the date on the list and confirm if there are any other changes to the patient's medications since the time the medication review was done
• Verify if the review shows actual medication use or only prescribed directions
• Not all patients may be eligible for a MedsCheck
• Bear in mind that a pharmacy profile printout does not qualify as a medication review (i.e., MedsCheck)

Benefits

• A record of all ODB medications that are dispensed
• Provides name and number of prescriber and community pharmacy for each medication that is listed.
• Able to retrieve one year of past medication information
• Indicates if a MedsCheck was completed
• As current as last medication dispensed
• Patient's consent to access the information is implied

Limitations

• Only records what was dispensed by community pharmacies and may not reflect actual use by the patient
• Does not include complete medication details (i.e., does not include exact dose or frequency)
• Patients may choose not to have any of their medications appear on the ODB DPV or only to have certain classes of medications appear
• Does not record if medications were discontinued
• Does not include medications not covered by ODB such as:
  • Nonprescription and/or non-provincial formulary medications
  • Medication samples
  • Investigational / clinical trial medications
  • "Specialty" medications (e.g. immunosuppressants, chemotherapeutic agents & vaccines)

Benefits

• Should include complete medication details (i.e., medication name, dose, route, frequency)
• Should include information about what medications were started, stopped or modified during the patient's previous hospital stay

Limitations

• Information may only be as current as a the date of discharge
• Information provided on BPMDP reflects how the medications were prescribed which may not always reflect how the patients is actually taking the medications

• Check the date on the discharge plan
• Confirm if there are any other changes to the patient's medications since the time of discharge
• Determine actual medication use by the patient after discharge from hospital
• Be aware of medication adjustments due to auto-substitution policies and medication adjustments due to formulary restrictions
• Original prescriber information may become lost (i.e., prescriber will appear as discharging physician and not original prescriber

Benefits

• May provide an explanation of changes made to medications during hospital visit

Limitations

• May not account for all medications the patient is taking
• May not provide complete medication details (i.e., medication name, dose, route, frequency)
• There may be a delay in the primary care provider receiving the discharge summary
• Medications may be changed due to auto-substitution policies in hospitals

Benefits

• May include rationale for medications added or changed

Limitations

• May not include complete information (i.e., medication name, date, dose, route, frequency)
• May not account for all medications the patient is taking
• May be a delay in the primary care provider receiving the information

Benefits

• BPMH completed by rapid response nurses should reflect changes made to medications in hospital. Patients are seen within 24-48 hours post-discharge from hospital
• Should include complete medication details (i.e., medication name, dose, route, frequency)
• Should include all the medications a patient is taking including prescription and nonprescription medications, vitamins, natural products etc.

Limitations

• Rapid response nurses may not have been provided with complete discharge information

Benefits

• Should include complete medication details (i.e., medication name, dose, route, frequency)
• Should include all the medications a patient is taking including prescription and nonprescription medications, vitamins, natural products etc.
• Nurses completing a medication history for patients enrolled in the program have weekly appointments with the patients providing them with many opportunities to confirm the patient's actual medication regimen

Limitations

• Service not available in all LHINs