How one doctor helps patients with medication reconciliation

Dr. Cicone and patient Chad Osborne

Changes to prescriptions and incomplete records can increase the risk of adverse reactions, particularly after a hospital discharge.

One physician addresses this issue by following up with all patients after hospitalization and making sure they bring all their current prescriptions to their follow-up visits.

“Most of my patients are admitted through St. Joe’s [St. Joseph Mercy] and their inpatient team is good at getting us a discharge summary before the patient arrives at my office,” said Bruce Cicone, M.D., who practices in Ypsilanti.

“An important part of the follow-up visit is to review medications and make sure patients understand why they’re taking certain medications, how to take them and to make sure they take them,” said Dr. Cicone.

“Most patients are honest if they haven’t taken their medications because they were waiting for their follow-up visit,” said Dr. Cicone. “But if the patient’s blood pressure or diabetes isn’t under control, for example, I’ll start digging deeper,” he continued. “I’ll ask if they’re taking their medications as prescribed. And I ask them to bring the medications next time they come. We’re now asking patients to bring all their medications at every office visit.”

Most of Dr. Cicone’s patients are managed by consultants working with St. Joe’s hospital and they use the same electronic medical record system that his practice uses. “So if there are any changes in medications, I’m looking at the same list as the specialists.”

Even so, he and his medical assistant review all a patient’s medications at each follow-up visit because their office protocol is to double-check all medications.

There are some challenges with patients who have more than one chronic condition and are taking multiple prescriptions. Even when insurance copayments are low, expenses can add up, said Dr. Cicone. “So we always look at alternatives to drugs based on price and what the patient can tolerate,” he said.

Dr. Cicone related an example of one patient who learned at the pharmacy that his drug was removed from a formulary.

“I spent that visit on the phone with the patient’s insurance company finding an alternative that would be adequate for him and something he could afford,” said Dr. Cicone.

Elderly patients can present unique challenges. “We sometimes see problems where patients are not taking their prescriptions correctly so we may ask visiting nurses and the patient’s family to get involved,” said Dr. Cicone.

In one instance, he asked an elderly patient to bring in all her medications because her blood pressure was not controlled. He learned that she kept all her pills in one vial, so it was apparent she was taking her medications randomly. That’s when the office made the decision to have patients bring the medications to each visit.

Dr. Cicone’s office prints a medication list and new instructions from the electronic medical record for each patient. It’s also helpful to review the medication list and the instructions for taking them. “When they leave here, I always point out to patients that they will get a new medication list from us that’s going to show their current drugs,” said Dr. Cicone. “We tell them they should check at home to make sure the medications I have on their list coincide with the ones they have at home.

“It’s time consuming,” concedes Dr. Cicone. “But you have to give it the attention it deserves or there are going to be errors.”