Assessing Medication Self-Management Challenges and Self-efficacy During Emergency Department Medication Reconciliation: An Evidence-based Quality Improvement Project

Abstract

Introduction: 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.