Evaluating Patients’ Perceptions of the Use of Secure Messaging for Medication Reconciliation During Transitions of Care
TimeThursday, April 152:17pm - 2:19pm EDT
Medication discrepancies, defined as unintended differences between what is documented in a patient’s medication record and what the patient reports taking, can lead to adverse drug events, emergency department visits, and hospital readmissions. Medication discrepancies often occur during a patient’s transition from an acute hospital setting to home. Medication reconciliation, the process of comparing the medications a patient reports taking to those in the medical record and resolving discrepancies, is recommended to prevent potentially harmful events associated with persistent medication discrepancies.
We developed the Secure Messaging for Medication Reconciliation Tool (SMMRT) to identify and reconcile medication discrepancies during the care transition from hospital to home. SMMRT uses secure messaging within the Veterans Affairs (VA) electronic patient portal. Our objective was to characterize patients’ perceptions of the SMMRT’s usability and effectiveness.
We conducted semi-structured interviews with a sample of patients from a randomized controlled trial of the SMMRT. These patients had received care in VA acute or sub-acute settings before discharge to home. As part of the larger study, patients were sent the SMMRT in PDF format via secure message, asked to confirm or correct their medication list, and return the SMMRT via secure messaging for review by a clinical pharmacist to reconcile discrepancies. All 118 patients in the trial who received the SMMRT intervention were invited to participate in a 30-minute phone interview. Interviews were conducted within two months of each subject’s completion of the intervention. Interviews were audio recorded, transcribed, and analyzed via an inductive, qualitative analysis approach to identify key themes. The qualitative analysis team consisted of one doctoral-level (PhD) scientist with formal qualitative methods training and experience and one master’s-level (MA) research assistant with qualitative experience. Both analysts independently coded two transcripts and then discussed any coding discrepancies until consensus agreement was reached. One analyst then proceeded with independently coding all remaining transcripts. When the analyst identified new potential themes, the analysis team came back together to discuss any potential theme(s) identified until reaching consensus. A subset of transcripts (5 participants, 25% sample) was independently analyzed and discussed by both analysts on a periodic basis over the course of the data analysis to ensure quality.
The twenty interview participants were all male with a mean age of 62.5 ± 9.5 years and a mean of 13.8 ± 2.4 years of education; 65% were white. Three quarters of the participants reported prior use of secure messaging. Most (16/20, 80%) participants reported regular daily computer use, of whom nearly all reported prior use of secure messaging (14/16, 87.5%). However, three (15%) of the interviewees reported using a computer only a few times with no prior secure messaging experience. One interviewee (5%) reported a caregiver using secure messaging on his behalf, despite no personal computer experience.
Overall, most (17/20, 85%) reported viewing the SMMRT at home following hospital discharge. Of those that viewed the SMMRT, 76% (13/17) reported that the SMMRT was easy to navigate, with appropriate font size that allowed for good readability. Patients felt that the SMMRT was time saving and liked that they could review it at their own pace and in the comfort of their own home where they had easier access to their daily medications. Overall, 29% (5/17) of patients reported the SMMRT helped clarify an issue relating to medication directions or dosages, and 71% (12/17) reported that the use of the SMMRT helped remove at least one medication erroneously listed in the patient’s medical record as “active” that had been previously discontinued by a physician. Those who returned the SMMRT via secure message (9/20, 45%) said things like, “I think everything was made as easy and accessible as possible. If I can do that, it should be doable by most anyone.” Other comments included “It helped me to understand my dosages a little better and get my [medication] regimen on track.”
Despite that most patients viewed the SMMRT once home, 11 (55%) did not return the SMMRT via secure messaging. Patient reported barriers related to using the technology included the inability to attach the SMMRT to the secure message (6/11, 55%), inability to save the completed tool (1/11, 9%), and patient portal access issues (i.e., logging into the platform) (2/11, 18%). An additional reported barrier to returning the SMMRT was time constraint due to personal health and family matters (2/11, 18%). Patients who did not return the SMMRT talked about their difficulty with downloading and uploading the SMMRT and reported issues like, “It had a lot of pages and it wouldn’t let me download all the pages.”
Importantly, nearly all (16/17, 94%) patients who viewed the SMMRT would recommend it to other patients transitioning from hospital to home, indicating that overall impressions of the SMMRT were positive.
Most patients used the SMMRT to review their medications at home after discharge and found that it was effective at identifying and correcting medication discrepancies. Despite the perceived effectiveness of the tool, computer literacy levels, difficulties using the patient portal and secure messaging, and time constraints were the greatest barriers to returning the SMMRT for clinical review. A patient’s computer literacy level and the usability level of asynchronous communication tools within an electronic patient portal may impede a patient’s use of the portal and its associated clinical tools. Alternative methods of engagement to prevent disruptions in patient-provider communication may be necessary for patients with limited computer experience or skills.