Ambulatory Medication Reconciliation and Frequency of Hospitalizations and Emergency Department Visits in Patients With Diabetes

• Published in: Diabetes care Vol. 41; no. 8; pp. 1639 - 1645
• Main Authors: Turchin, Alexander, Sosina, Olukayode, Zhang, Huabing, Shubina, Maria, Desai, Sonali P, Simonson, Donald C, Testa, Marcia A
• Format: Journal Article
• Language: English
• Published: United States American Diabetes Association 01.08.2018
• Subjects: Adult; Adults; Aged; Ambulatory Care - statistics & numerical data; Demographics; Demography; Diabetes; Diabetes mellitus; Diabetes Mellitus - epidemiology; Diabetes Mellitus - therapy; Disease management; Drugs; Emergencies - epidemiology; Emergency medical care; Emergency medical services; Emergency Medical Services - statistics & numerical data; Emergency Service, Hospital - statistics & numerical data; Feedback; Female; Health care; Health care facilities; Health services utilization; Hospitalization; Hospitalization - statistics & numerical data; Humans; Hypoglycemic Agents - therapeutic use; Male; Medication Reconciliation - methods; Medication Reconciliation - statistics & numerical data; Middle Aged; Patient Acceptance of Health Care; Patient admissions; Patients; Primary Health Care - methods; Primary Health Care - standards; Primary Health Care - statistics & numerical data; Research design; Retrospective Studies
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/dc17-1260

To investigate the association between ambulatory medication reconciliation and health care utilization in patients with diabetes. In this retrospective cohort analysis, we studied adults taking at least one diabetes medication treated in primary care practices affiliated with two academic medical centers between 2000 and 2014. We assessed the relationship between the fraction of outpatient diabetes medications reconciled over a 6-month period and the composite primary outcome of combined frequency of emergency department (ED) visits and hospitalizations over the subsequent 6 months. Among 261,765 reconciliation assessment periods contributed by 31,689 patients, 176,274 (67.3%), 27,775 (10.6%), and 57,716 (22.1%) had all, some, or none of the diabetes medications reconciled, respectively. Patients with all, some, or no diabetes medications reconciled had 0.354, 0.377, and 0.384 primary outcome events per 6 months, respectively ( < 0.0001). In a multivariable analysis adjusted for demographics and comorbidities, having some or all versus no diabetes medications reconciled was associated with a lower risk of the primary outcome (rate ratio 0.94 [95% CI 0.90-0.98; = 0.0046] vs. 0.92 [0.89-0.95; < 0.0001], respectively). Introduction of feedback to individual providers was associated with a significant increase in the odds of all diabetes medications being reconciled (2.634 [2.524-2.749]; < 0.0001). A higher fraction of reconciled outpatient diabetes medications was associated with a lower frequency of ED visits and hospitalizations. Individual performance feedback could help to achieve more comprehensive medication reconciliation.