Dosing Errors - Fragmentation of Care | Arthritis Information
This one paragraph sums it all up:
The management of chronic disease among outpatients is complicated by (1) increasing severity of illness18 and aging of the population,19 (2) formidable costs20 but limited reimbursement21 for medications, (3) decreasing prevalence of insurance coverage,22-23 (4) increasing documentation burden during brief patient visits,13 (5) shortened lengths of stay in acute care facilities,24 and (6) fragmentation of care.25 In this environment, and in the absence of centralized medical records (whether electronic or not), providers prescribe in a black box. Once prescriptions are given to a patient or pharmacy by hand, mail, or telephone, there are no reliable means of knowing whether or not a prescription was filled, whether the appropriate medication was received or administered, and what the time frame for each of these factors was. Consequently, monitoring the safety and efficacy of a medication depends on assumptions that an appropriate prescription was properly transcribed, that numerous individuals including the patient and pharmacist followed instructions, that no restricted payer formulary intervened, and that the patient or a surrogate is able to report accurately about all of these factors. Emphasis added.
A whole lot of medication problems could/would be eliminated if a system was available enabling a pharmacy to forward the prescription and the date a prescription was filled to the doctor to be recorded on the patient's file. Since many patients use more than one pharmacy all pharmacists would have to forward this information.
Patients who either forgot or have chose not to provide a complete list of their prescription meds. would no longer be able to do so.
Yes everything at my RD is done on the computer. A couple of weeks ago i tried to tell the nurse i did not get one of my scripts. It was my prednisone. So i made a new appiontment. This time they started to send me home with out three scripts. I said something and the nurse listened and corrected it. The doc had already left for lunch. I got it straightened out. I am going to have him write on paper next visit what i am for sure to take. So i know if the computer is printing out everything it is supposed to. Argg!!! Who knows if i forgot something and did not ask? Years ago for my imflamatory bowel disease the pharmacist mixed up my pain pills with my diarea ? check spelling, well lets just say I got clogged and not as much pain relief as i should have gotten. As i was taking two diarea pills every four hours for pain. And one pain pill every day for diarea. So when i get a new med i do not know what it looks like. I wonder what is in the bottle.All my healthcare providers communicate with each other. If I get an X-ray or something, a copy of it goes into each one of my Dr's folders. My PT, OT, and RD are all in the same building and have scheduled meetings to discuss patients. Not everybody's care is so streamlined (just if you get treated ata "centre"). When my Mom had cancer and was being treated at the cancer centre the service was INCREDIBLE. It was all streamlined so once you were in you just automatically got set up with nutritionists and homecare workers and counsellors and whatever else was needed. It took the stress of making arrangements and appointments right off of us. I guess that's just another area where integrated social healthcare gets more efficient.
That said, things still fall through the cracks, details get missed sometimes, and I have to keep track of any CAM I do, as well as dental meds and that kind of stuff.My docs also regularly communicate with each other... and they don't even practice at the same hospital, much less work in the same clinic. I could choose physicians who work in a center/clinic/etc, but I prefer the doctors I have right now.
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