Participatory research to improve medication reconciliation for older adults in the community.
Date
2023-02
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Abstract
Introduction
Medication reconciliation, a technique that assists in aligning a care team's understanding of an individual's true medication regimen, is vital to optimize medication use and prevent medication errors. Historically, most medication reconciliation research has focused on institutional settings and transitional care, with comparatively little attention given to medication reconciliation in community settings. To optimize medication reconciliation for community-dwelling older adults, healthcare professionals and older adults must be engaged in co-designing processes that create sustainable approaches.Methods
Academic researchers, older adults, and community- and health system-based healthcare professionals engaged in a participatory process to better understand medication reconciliation barriers and co-design solutions. The initiative consisted of two participatory research approaches: (1) Sparks Innovation Studios, which synthesized professional expertise and opinions, and (2) a Community Consultation Studio with older adults. Input from both groups informed a list of possible solutions and these were ranked based on evaluative criteria of feasibility, person-centeredness, equity, and sustainability.Results
Sparks Innovation Studios identified a lack of ownership, fragmented healthcare systems, and time constraints as the leading barriers to medication reconciliation. The Community Consultation Studio revealed that older adults often feel dismissed in medical encounters and perceive poor communication with and among providers. The Community Consultation Studio and Sparks Innovation Studios resulted in four highly-ranked solutions to improve medication reconciliation: (1) support for older adults to improve health literacy and ownership; (2) ensuring medication indications are included on prescription labels; (3) trainings and incentives for front-line staff in clinic settings to become champions for medication reconciliation; and (4) electronic health record improvements that simplify active medication lists.Conclusion
Engaging community representatives with academic partners in the research process enhanced understanding of community priorities and provided a practical roadmap for innovations that have the potential to improve the well-being of community-dwelling older adults.Type
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Doucette, Lorna, Bridget T Kiely, Jennifer M Gierisch, Eve Marion, Lisa Nadler, Mitchell T Heflin and Gina Upchurch (2023). Participatory research to improve medication reconciliation for older adults in the community. Journal of the American Geriatrics Society, 71(2). pp. 620–631. 10.1111/jgs.18132 Retrieved from https://hdl.handle.net/10161/29268.
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Jennifer M. Gierisch
Jennifer Gierisch, PhD, is behavioral scientist and health services researcher. She is an Associate Professor in the Department of Population Heath Sciences and the Department of Medicine at Duke University. She is a core investigator with the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) where she serves as the leader of the Partnered Research Methods Core (PRESTO) and Director of the VA OAA Health Services Research Postdoctoral Fellowship. Dr. Gierisch also is the Co-Director of the Evidence Synthesis Program (VA ESP) at the Durham Veteran Affairs Health Care System. She also served as a faculty director of the Duke Clinical Translational Science Institute's Community Engaged Research Initiative (CeRi) for five years
Dr. Gierisch’s research focuses on three overarching areas: 1) behavioral research on the psychosocial factors that influence appropriate uptake and maintenance of complex health behaviors (eg., weight management, smoking cessation, cancer screening); 2) evidence synthesis on key health and healthcare topics to enhance uptake of evidence-based interventions to improve patient and health system outcomes; and 3) participatory and community engaged research approaches.
Area of expertise: health behavior, community-engaged research, evidence synthesis, intervention development, qualitative research
Mitchell Tod Heflin
I am currently a Professor with Tenure in the Department of Medicine, a Senior Fellow in the Duke Center for the Study of Aging and Human Development, and Associate Dean for Interprofessional Education and Care (IPEC). My career as a leader in Geriatrics has focused on development, deployment and evaluation of education programs aimed at health professions learners from a variety of disciplines and introduction of innovative models of care with a specific emphasis on community-based and perioperative care of frail older adults. I served as Geriatrics Fellowship Program Director for 11 years and, over the same span, directed HRSA funded Geriatrics Education Programs at Duke, including our Geriatric Workforce Enhancement Program (GWEP) In that role, I worked with colleagues and community partners to provide IP educational programs in geriatrics and care redesign in primary care practices to improve care for older adults. Concurrently, I also led the implementation of the Duke Perioperative Optimization of Senior Health (POSH) program and co-directed the VA OAA funded Specialty Care Education Center of Excellence for the VA POSH Program. In my current role as Associate Dean and Director of the IPEC Center, I am working with educators and clinicians from across the Health System in the design and implementation of educational program aimed at improving our ability to use interprofessional collaborative practice to deliver safe, effective, person-centered care.
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