Comparison of MedBook Portal and Usual Care in Medication Reconciliation at Primary Healthcare Upon Hospital Discharge
NCT Number: NCT06517160
Acronym: MEDRECON
Status: COMPLETED
Study Type: INTERVENTIONAL
Phases: NA
Conditions: Medication Reconciliation
Interventions: OTHER: MedBook Portal
Sponsor: Ministry of Health, Malaysia
Collaborators: University Malaysia Sarawak
Sex: ALL
Age: ADULT, OLDER_ADULT
Enrollment: 368
Study Design: Allocation: RANDOMIZED|Intervention Model: PARALLEL|Masking: NONE|Primary Purpose: HEALTH_SERVICES_RESEARCH
Start Date: 2023-05-02
Completion Date: 2024-06-26
Locations: Sarawak State Health Department, Kuching, Sarawak, 93050, Malaysia

Summary:
A randomized controlled trial was conducted to examine the efficacy of the MedBook portal in reducing medication discrepancies after discharge. The MedBook portal is a webpage that enables the sharing of patient medication profiles among healthcare facilities under the Ministry of Health. A total of 368 adult patients in general medical wards, who were discharged from Sarawak General Hospital, Sibu Hospital, Miri Hospital, and Sarikei Hospital, and referred to ten public primary health clinics located near these hospitals, were recruited for this study. Eligible subjects were randomized into an intervention group and a control group in a 1:1 ratio. This study was conducted from May 2023 to June 2024.

Study pharmacists conducted medication reconciliation before randomization by comparing the discharge prescription with the pre-admission medications and inpatient medication charts to identify discrepancies. Discrepancies were confirmed with the doctor to determine if they were intentional or unintentional.

Control group patients received standard care, with discharge notes and appointment dates provided upon discharge. In Malaysia, there is no shared electronic medication record system between primary and secondary healthcare; thus, information is transferred manually via discharge notes and home-based medical cards. During initial health clinic visits, doctors reviewed patients' medical records based on home-based medical cards and discharge notes, if available. Pharmacists conducted medication reconciliation by comparing new prescriptions with previous records. Discrepancies were confirmed with the doctor to determine if they were intentional or unintentional. Control group doctors could not access the MedBook Portal, and no MedBook Portal Notice was attached to home-based medical cards.

The MedBook Portal Notice was attached to patients' home-based medical cards for identification at follow-up appointments. Doctors logged into the MedBook Portal to access discharge medication lists and conducted medication reconciliation by comparing discharge prescriptions with new prescriptions. Study pharmacists screened patients' home-based medical cards at the pharmacy, identified recruited patients via the MedBook Portal Notice, and conducted medication reconciliation by comparing new prescriptions with discharge medication lists in the portal. Discrepancies were confirmed with the doctor to determine if they were intentional or unintentional.

Primary Outcome Measures: Percentage of prescriptions with medication discrepancies in the first prescription during the first follow-up visit at the primary health clinic after hospital discharge, (Number of prescription with medication discrepancies during 1st health clinic follow up)/(Total prescription reconcilled at health clinic (with or without MedBook Portal)), From enrollment to the first appointment date at the selected primary health clinic, the time frame might range from 1 week to 2 months
Secondary Outcome Measures: Percentage of prescriptions with medication discrepancies in the discharge prescription, Number of prescription with medication errors/ Total prescription reconcilled upon discharge, From enrollment to hospital discharge, time time frame might range from 1 hour to 2 days.|Type of medication discrepancies, Number of medication discrepancies detected will be grouped into 0, 1, 2, 3, 4, 5 errors. Chi-square test will be used to analyse the association of medication discrepancies at intervention group versus control group., From enrollment to the first appointment date at the selected primary health clinic, the time frame might range from 1 week to 2 months|Predictors associated with medication discrepancies, Multiple logistic regression, From enrollment to the first appointment date at the selected primary health clinic, the time frame might range from 1 week to 2 months