Evaluation of the
Primary Care Reimbursement Services
data as a source of pre-admission
medication information
Grimes T.1,2, Fitzsimons M.1, Galvin M.3,
Delaney T.4, Flanagan S.4
1Adelaide
and Meath Hospital, inc. the National Children’s Hospital, Dublin;
2School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin;
3Naas General Hospital, Kildare;
4Health Services Executive.
Admission
Reconcile
Pre-admission
medication list
(PAML)
Inpatient
prescribing
What medication did the patient
ACTUALLY use before admission?
The Gold Standard PAML (GS-PAML)
Discharge
prescribing
The challenge
• 400,000 emergency inpatient discharges
• 39% total inpatients aged 65+ years
– ESRI HIPE Annual Report 2009
• Polypharmacy is common in older persons
– Ryan C et al., Br J Clin Pharm 2010
• Increasing multimorbidity
– Mercer SW et al., Family Practice, 2009
• Advances in preventative medicine
Pre-Admission Medication (PAM) Information
•
Availability and reliability of sources of PAM info
•
Setting: Two acute, public hospitals
•
Study design: Observational study
•
Study sample: Random selection of adults, admitted via A&E, using
3+ meds
•
Data management: SPSS®, version 15
•
Feb to May 2009
Fitzsimons M., et al. Drug Utilisation and Research Group, UK and Ireland, London, 2010
1. Patient interview
3. Patient corroboration
2. External corroboration
•General Practitioner – verbal
•GP referral letter
•Community Pharmacist – verbal
•Patient’s own drugs (PODs)
•Nursing home list
•Nursing home – verbal
•Inpatient Kardex (previous 6/12)
•Inpatient summary (previous 6/12)
•PCRS data
Gold Standard
Pre-Admission Med List
4. Compare
Primary Care Reimbursement Services
(PCRS)
•
General Medical Services (GMS) scheme
– aka Medical card holders
•
Centralised records
•
Retrospective review of PCRS dispensed records
•
Research question:
•
Do PCRS dispensed records provide reliable PAM information for
medical card patients?
•
How does this compare to other sources of information?
Findings
• 134 patients recruited to original study
• 97 (72%) patients with GMS medical cards
• 92 of 97 identified on PCRS system
• 90 of 92 had medication dispensed under the GMS
Scheme during the study period
Factor A
Source
Potential
for use
B
C
Availability
Agree
with
No. Of disagreement
per
episode
GS-PAML
(mean)
n(%)
n(%)
n(%)
Grading Rank
A*(B+C)
134 (100)
132 (99)
49 (37)
3.3
136
1
Community pharmacy 134 (100)
126 (94)
21 (17)
2.5
111
2
Patient/ carer
PCRS
97 (72)
90 (93)
15 (17)
2.9
79
3
GP surgery
134 (100)
88 (66)
9 (10)
3.3
76
4
Inpatient Kardex
50 (37)
34 (68)
2 (6)
4.8
27
5
POD
134 (100)
58 (43)
2 (3)
4.6
46
6
GP referral letter
53 (40)
42 (79)
1 (2)
6.2
32
7
Discharge summary
50 (37)
29 (58)
1 (3)
6.9
23
8
NH staff
9 (7)
9 (100)
8 (89)
0.2
13
9
NH list
9 (7)
6 (67)
1 (17)
1.7
6
10
Types of disagreement
PCRS
Discharge summary
Kardex
NH staff
NH list
Omission
Commission
POD
Dose/ Frequency
Other
GP letter
GP surgery
CP
Patient/ carer
0%
20%
40%
60%
Percentage of disagreements
80%
100%
Strengths & Limitations
• Small sample size
• Two study sites
• Random sampling
Conclusions
• For medical card holders
– Similar degree of agreement with GS-PAML as Community
Pharmacy
– Avoid interruptions to primary care clinicians
• Future work
– Explore opportunities and challenges to make PCRS data
available in the hospital setting
Agreement of sources with GS-PAML
Per medication
Mean #
disagreement
s per episode
Per episode
Agreement
Frequency n
(%)
N
Frequency n
(%)
N
Patient/ carer
49
37.1
132
960
68.4
1403
3.4
POD
2
3.4
58
350
56.7
617
4.6
GP letter
1
2.4
42
189
44.1
456
6.2
GP surgery
9
10.2
88
656
69.3
946
3.3
Comm’ Pharm’
21
16.7
126
1025
76.8
1334
2.5
Inpt kardex 6/12 2
5.9
34
262
61.5
426
4.8
DCS 6/12
1
3.4
29
191
48.8
391
6.9
NH list
1
16.7
6
89
89.9
99
1.7
NH staff
8
88.9
9
125
98.4
127
0.2
PCRS GMS
15
16.7
90
757
74.1
1021
2.9