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Medication Discussions With Patients With Cardiovascular Disease in the Emergency Department: An Opportunity for Emergency Nurses to Engage Patients to Support Medication Reconciliation

Published:January 07, 2023DOI:https://doi.org/10.1016/j.jen.2022.12.002

      Abstract

      Introduction

      This study aimed to investigate the level of patient involvement in medication reconciliation processes and factors associated with that involvement in patients with cardiovascular disease presenting to the emergency department.

      Methods

      An observational and cross-sectional design was used. Patients with cardiovascular disease presenting to the adult emergency department of an academic medical center completed a structured survey inclusive of patient demographics and measures related to the study concepts. Data abstracted from the electronic health record included the patient’s medical history and emergency department visit data. Our multivariable model adjusted for age, gender, education, difficulty paying bills, health status, numeracy, health literacy, and medication knowledge and evaluated patient involvement in medication discussions as an outcome.

      Results

      Participants’ (N = 93) median age was 59 years (interquartile range 51-67), 80.6% were white, 96.8% were not Hispanic, and 49.5% were married or living with a partner. Approximately 41% reported being employed and 36.9% reported an annual household income of <$25,000. Almost half (n = 44, 47.3%) reported difficulty paying monthly bills. Patients reported moderate medication knowledge (median 3.8, interquartile range 3.4-4.2) and perceived involvement in their care (41.8 [SD = 9.1]). After controlling for patient characteristics, only difficulty paying monthly bills (b = 0.36, P = .005) and medication knowledge (b = 0.30, P = .009) were associated with involvement in medication discussions.

      Discussion

      Some patients presenting to the emergency department demonstrated moderate medication knowledge and involvement in medication discussions, but more work is needed to engage patients.

      Key words

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      Biography

      Deonni P. Stolldorf is Assistant Professor, Vanderbilt University School of Nursing, Nashville, TN. Twitter: @research_dee. ORCID identifier: https://orcid.org/0000-0002-1352-5397.

      Biography

      Abby B. Jones is Research Assistant, Vanderbilt University School of Nursing, Nashville, TN. ORCID identifier: https://orcid.org/0000-0002-6934-7593.

      Biography

      Karen F. Miller is Senior Associate, Center for Emergency Care Research and Innovation, Vanderbilt University Medical Center, Nashville, TN. ORCID identifier: https://orcid.org/0000-0003-3474-3390.

      Biography

      Hadassah H. Paz is Clinical Translational Research Coordinator III, Vanderbilt University Medical Center, Nashville, TN. ORCID identifier: https://orcid.org/0000-0001-5390-0393.

      Biography

      Bryn E. Mumma is Associate Professor, University of California, Davis School of Medicine, Sacramento, CA. Twitter: @mummabem. ORCID identifier: https://orcid.org/0000-0002-2900-2048.

      Biography

      Valerie C. Danesh is Research Scientist, Center for Applied Health Research, Baylor Scott & White Research Institute, Dallas, TX. Twitter: @DaneshVC. ORCID identifier: https://orcid.org/0000-0002-2078-2578.

      Biography

      Sean P. Collins is Professor of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN. ORCID identifier: https://orcid.org/0000-0002-2305-9836.

      Biography

      Mary S. Dietrich is Professor, Statistics and Measurement, Vanderbilt University School of Medicine, Vanderbilt University School of Nursing, Nashville, TN. ORCID identifier: https://orcid.org/0000-0003-4474-0767.

      Biography

      Alan B. Storrow is Associate Professor and Associate Director for Research, Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN. ORCID identifier: https://orcid.org/0000-0002-2893-808X.