Whose Job Is It Anyway? Swedish General Practitioners’ Perception of Their Responsibility for the Patient’s Drug List

Medication reconciliation, assuring agreement between patients and providers regarding what medications they are using, is a key element of safe medication use. In the U.S., the Institute of Medicine, the Joint Commission, and the Institute for Safe Medication Practices emphasize the importance of medication reconciliation as patients move through the health care system.1, 2, 3 Many more patients are moving from one physician to another in outpatient clinics than in hospitals, yet more systems emphasis is placed on the inpatient medication reconciliation process. The medication reconciliation process is tedious, detail oriented work, but is of great importance in terms of medication safety. And who is responsible for this task? Everyone is.

Some patients are capable of managing their own medications, but those who are incapacitated by illness and/or have limited health literacy skills are the least able to manage their medicines.4 Care must be taken at every encounter; especially at the point of transfer of care, to make sure the prescriber knows what medications the patient is currently taking. This is the only way to prevent omissions, duplications and drug interactions. Asking about over-the-counter, complementary and alternative therapies are also important as many of these products have potential drug interactions that need to be considered.

It is not surprising that some physicians are more motivated to maintain an accurate medication list than others. Any excuse for failing to maintain an accurate list is without merit. Documentation of who prescribes each medication, if other than the family physician, can help office staff refer a patient to the specialist if they call for a refill of a high risk medication outside the realm of family medicine. Collaboration with community pharmacists provides key information regarding not only medication adherence, but also information regarding duplicate medication prescribing by different physicians. Inpatient pharmacists can provide valuable input by assisting with medication histories and patient counseling at discharge.5

An open line of communication between specialists and primary care physicians is critical to assuring safe and appropriate medication use. Nurses, pharmacists, pharmacy technicians, and medical assistants can be very helpful in the process of maintaining medication records, but the ultimate responsibility falls on each prescriber.

1. Institute of Medicine Report “To err is human. Building a safer heath care system” http://www.iom.edu/Reports/1999/To-Err-is-Human- Building-A-Safer-Health-System.aspx 2. The Joint Commission http://www.jointcommission.org/ 3. Institute for Safe Medication Practices http://www.ismp.org/ 4. Neilson-Bohlman L, Panzer A, Kinding D, eds. Health Literacy: A Prescription to EndConfusion. Washington, DC: National Academies Press, 2004. 5. American Society of Health-System Pharmacists. Goal 1 of the 2010 Initiative. http://www.ashp.org/s_ashp/docs/files/2015_Goals_Objectives_0508.pdf

Competing interests:   None declared