Comparison of MedBook Portal and Usual Care in Medication Reconciliation at Primary Healthcare Upon Hospital Discharge

NCT06517160 | Completed

• 1 other identifier: NMRR-22-02409-ODX
• Study Type: interventional
• Target: 398
• Locations: 1 country
• Sites: 1

Brief 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 398 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 July 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.

Conditions

Medication Reconciliation

Keywords

Medication Reconciliation; Medication Safety; Unintentional Medication Discrepancies; Primary Healthcare; Transition of Care; Electronic Health Record

Outcome Measures

Primary Outcomes (1)

• 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 Outcomes (3)

• Percentage of prescriptions with medication discrepancies in the discharge prescription

  From enrollment to hospital discharge, time time frame might range from 1 hour to 2 days.

• Type of medication discrepancies

  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

  From enrollment to the first appointment date at the selected primary health clinic, the time frame might range from 1 week to 2 months

Study Arms (2)

Control Group

NO INTERVENTION

Patients will receive standard care, where doctors review previous medical records in the home-based medical card and discharge notes if provided by the patient during their first review. Doctors cannot access the patient's discharge medication list from the MedBook Portal, and no MedBook Portal Notice is attached to the patient's home-based medical card. The principal investigator will give a list of control group patients to the study pharmacist at the health clinic. Knowing their appointment dates, the study pharmacist will search for the first prescription after transitioning care from the hospital to the primary health clinic. The study pharmacist will then compare the discharge prescription in the MedBook Portal with the first prescription to identify medication discrepancies. Any discrepancies will be addressed by confirming with the doctor whether they are intentional or unintentional.

Intervention Group

EXPERIMENTAL

MedBook Portal Notice will be attached to the patient's home-based medical card for doctors and pharmacists at health clinics to identify recruited patients during their first follow-up after hospital discharge. During the doctor's review of intervention group patients, the doctor will log in to the MedBook Portal to check the discharge medication list and review the case based on the previous medical record in the home-based medical card and the discharge note, if provided. The doctor will then conduct medication reconciliation by comparing the discharge prescription with the new prescription. Study pharmacists at health clinics will screen patients' home-based medical cards when collecting medications. Study pharmacists will retrieve the discharge prescription from the MedBook Portal and conduct medication reconciliation by comparing the discharge prescription with the new prescription. Any discrepancies will be addressed by confirming with the doctor whether they are intentional.

Other: MedBook Portal

Interventions

MedBook Portal OTHER

Intervention Group (With MedBook Portal \& MedBook Portal Notice) 1. MedBook Portal Notice in front of the patient home-based medical card 2. Discharge prescriptions are uploaded into MedBook Portal and can be retrieved by doctors \& pharmacists. MedBook portal (https://aplikasi.jknsarawak.moh.gov.my/medbook) is a webpage that enable sharing of patient medication records among healthcare facilities under Ministry of Health. Sarawak State Health Department owned and managed this portal. All the information is kept under their server. Doctors in the Health Clinics and Study Pharmacists will be given access to this portal whereby each of the healthcare providers shall log in using their Identification Number and the password created by them. Doctor shall log in to MedBook Portal to check on discharge medication list when reviewing the patient at health clinic. MedBook Portal can be accessed both using a smartphone or a computer.

Intervention Group

Eligibility Criteria

• Age: 18 Years - 100 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Adult patients aged 18 years and above in general medical wards.
• Patients who had any of the following comorbidities: (1) cardiovascular related diseases, e.g.: hypertension, acute coronary syndrome, heart failure, stroke, atrial fibrillation; (2) endocrine related diseases, e.g.: diabetes, thyroid disorders; (3) renal related diseases, e.g.: chronic kidney disease, end stage renal failure; (4) respiratory related diseases, e.g.: asthma, chronic obstructive pulmonary disease.
• Patients who are referred to the selected primary health clinics after hospital discharge.
• Patients with home-based medical card.

You may not qualify if:

• Patients discharged during public holidays or weekends will be excluded from this study.

Sponsors & Collaborators

• Ministry of Health, Malaysia: lead
• University Malaysia Sarawak: collaborator

Study Sites (1)

Sarawak State Health Department

Kuching, Sarawak, 93050, Malaysia

Location

Related Publications (1)

• Phang YY, Kuan JW, Oh AL, Ting CY, Osman NA, Moses S. Effectiveness of digital platform in reducing unintentional medication discrepancies at transition of care from hospital discharge to primary healthcare settings: a randomised controlled trial. BMC Prim Care. 2025 Jul 2;26(1):206. doi: 10.1186/s12875-025-02904-z.

  PMID: 40604512 DERIVED

Related Links

• This study was registered with the Medical Research \& Ethics Committee, Ministry Of Health Malaysia, under registration number NMRR ID-22-02409-ODX (IIR) on 30 November 2022.

Study Officials

• Yen Yen Phang

  Sarawak State Health Department

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Masking Details: Doctors at health clinics were not aware of the subjects in the control group.
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER GOV
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator/ Senior Principal Assistant Director (Pharmacy Practice & Development)

Study Record Dates

• First Submitted: July 18, 2024
• First Posted: July 24, 2024
• Study Start: May 2, 2023
• Primary Completion: July 24, 2024
• Study Completion: July 24, 2024
• Last Updated: September 19, 2024

Record last verified: 2024-09

Data Sharing

• IPD Sharing: Will not share

Locations

MY (1)