OLUKAYODE SOSINA, HUABING ZHANG, MARIA SHUBINA,SONALI P. DESAI, DONALD C. SIMONSON, MARCIA A. TESTA

Effect of Medication Reconciliation on Emergency Department Visits and Hospitalizations in Patients with Diabetes. ALEXANDER TURCHIN, OLUKAYODE SOSINA, HUABING ZHANG, MARIA SHUBINA,SONALI P. DESAI, DONALD C. SIMONSON, MARCIA A. TESTA, Boston, MA; Baltimore, MD and Beijing, China

Medication reconciliation is one of The Joint Commission’s National Patient Safety Goals. However, patient outcomes after medication reconciliation remain uncertain. Patients with diabetes (DM) are at high risk from medication errors as adverse drug events stemming from use of DM medications commonly lead to ED visits and hospitalizations. We retrospectively studied adults with DM treated in primary care clinics affiliated with two academic medical centers between 2000 and 2014. We analyzed the relationship between ambulatory reconciliation of DM medications (individual medication review by a clinician) over a 6-month treatment assessment period and frequency of ED visits and hospitalizations over the subsequent 6-month outcome assessment period (a single patient could contribute multiple assessment periods). Among 261,765 study periods representing 31,689 patients, 176,274 (67.3%) had all, 27,775 (10.6%) had some and 57,716 (22.1%) had no DM medications reconciled. Over the subsequent 6-month outcome assessment period patients with all, some or no DM medications reconciled had 0.223, 0.232 and 0.230 ED visits, respectively (p = 0.0296). Over the same period of time, patients with all, some or no DM medications reconciled had 0.132, 0.145 and 0.154 hospitalizations, respectively (p < 0.0001). In multivariable analysis adjusted for clustering within patients, comparing to patients with no DM medications reconciled, patients with some medications reconciled had fewer ED visits (-0.056 visits / 6 months; p = 0.037) and hospitalizations (-0.076; p = 0.026). Patients with all DM medications reconciled had fewer ED visits (-0.041; p = 0.018); the effect on hospitalizations did not reach significance (-0.027; p = 0.22). Patients who had at least some of their DM medications reconciled had lower healthcare utilization. Medication reconciliation could therefore contribute not only to improving patient safety but also to lowering costs of care.

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