Case Study | eConsults for Medication Review and Reconciliation in Primary Care

According to a study published in JAMA, nearly 60% of Americans take prescription drugs and 36% of adults aged 18 and over are taking three or more prescription medications. This increases the risk of adverse drug interactions and complications, jeopardizing patient safety and clinical outcomes. Therefore, the need for primary care providers to perform medication review and reconciliation is more important than ever to ensure patient safety and clinical quality.

Challenges in Medication Management in Primary Care

The clinical team bears a substantial responsibility to ensure the safety, efficacy, and appropriateness of prescribed medications.  There is a lot to know and cover given the intricate interplay of factors such as polypharmacy, comorbid conditions, and the ever-expanding pharmacopeia.  At every patient visit and during care transitions, providers must review medications to identify and resolve discrepancies to prevent both medication errors and adverse drug events.

Primary care providers face steep challenges in managing medications efficiently and effectively. Time constraints, limited access to specialist input, fragmented care with multiple providers, and the complexities of polypharmacy can all hinder optimal medication management. Addressing these challenges requires a multifaceted approach, including enhancing communication and coordination among healthcare providers and improving technological systems.

eConsults enhance clinical quality, reduce risk, and promote safety

The implementation of eConsults is a way to use technology to improve communication between PCPs and specialists, increase access to care, and enhance care coordination. Specialty eConsults for medication review and reconciliation present a streamlined way to obtain expert input on medication regimens.  This can significantly elevate the level of treatment provided to patients when any uncertainty exists.  

Did you know? Adverse drug events (ADEs) are a significant concern, accounting for nearly 700,000 emergency department visits and 100,000 hospitalizations annually in the United States. 

Key benefits of medication review eConsults

Primary care teams can delegate and defer to a top specialist(s) to assess a patient’s current medications, including prescription drugs, over-the-counter medications, and supplements. This helps identify potential drug interactions, duplications, or other issues that could impact the patient’s health.

Specialists offer timely insights to primary care teams, which are beneficial to those teams in the context of medication review in the following ways:

1. Optimization of therapeutic regimens

Specialists can provide guidance to optimize therapeutic regimens with medical reconciliation eConsults.  By identifying opportunities to adjust medication doses for safety or to achieve therapeutic levels, specialists can optimize therapeutic regimens. 

For example, in a series of eConsults reviewed by RubiconMD’s clinical team, there was a significant number (42%) who recommended increasing doses of Metformin to achieve therapeutic levels, but in cases of renal insufficiency (3%) recommended decreasing it in order to provide customized, patient-centric care.

2. Guidance on Drug Interaction 

Specialists can help PCPs identify potential adverse drug interactions early, review options to manage unwanted side effects, and address supplement interactions or other issues that could impact the patient’s health or prevent harm.

3. Rapid Access to Expertise in Specific Drug Therapies

Specialists have in-depth knowledge of advanced drug therapies and recommend optimal treatment options and contraindications tailored to specific conditions.

4. Safer Management of Complex Conditions

For patients with complex conditions and co-existing diseases, specialists can suggest modifications or alternatives to current prescriptions to prevent drug interactions. A study by Omboni and Caserini in 2020 demonstrated improved management of chronic diseases through telemedicine approaches.

5. Enhanced Accuracy in Medication Lists

eConsults offer a median turnaround time of just 3.5 hours, which facilitates more timely updates and reviews of patient medication lists.  This leads to higher accuracy and reduced medication errors.  

6. Reduced Hospital Readmissions

Effective medication reconciliation through eConsults can lower the risk of hospital readmissions due to medication errors or adverse drug interactions.

7. Ongoing Clinical Education and Training

Specialists provide education and training to primary care providers and staff on the latest guidelines and best practices in medication management. They offer resources and tools to help primary care teams conduct thorough medication reviews and reconciliations.

8. Updates on Pharmaceutical Research

Specialists stay abreast of the latest research and clinical trials, which can influence drug choice and treatment plans.

9. Personalized Medicine Approaches

With advances in genetics and pharmacology, specialists can offer insights into personalized medicine, potentially adjusting medications based on genetic markers.

10. Improved Patient Outcomes & Satisfaction

With specialist input, PCPs can make informed decisions that lead to better patient outcomes. 

Patients benefit from holistic and coordinated care, which improves their satisfaction and trust in the healthcare system.

To explore eConsult case examples featuring medication review through various specialties, download the case study below.