Acknowledgements

The Project CHANCE committee gratefully acknowledges the

contributions of those who made this possible. Mahmoud Moukalled

designed and programmed our database, and then graciously made

changes and updates after every event. We’re also especially grateful

to the staff and patients at Benton Plaza and Benton County Health

Center for their participation in this project.

APhA-ASP Project CHANCE with the

Community Health Centers of Benton and Linn County:

A Medication Reconciliation ProjectLevine P, Kong B, Van Devender EA, Leinbach M, Moukalled K, DeLander G and Ramirez S

Oregon State University, College of Pharmacy, Corvallis, OR 97331

Introduction

Community Health Centers of Benton and Linn Counties

(CHCBLC), a federally qualified 340B entity, served more than

6000 patients in 2007. We have worked together to implement a

medication reconciliation project that is intended to improve

wellness by decreasing medication errors, duplication or adverse

interactions. Medication reconciliation services have been

demonstrated to play an important role in reducing medical

errors, and pharmacists or pharmacy students can have a direct

impact in this area.

CHCBLC has four locations in Corvallis and surrounding rural

Oregon communities. CHCBLC offers services to anyone, with

or without health insurance. Costs are established by an income

based sliding-fee scale. Patients can receive prescriptions

through an outpatient pharmacy contracted to provide

medications through the 340B program. Many patients receive

all medical care through CHCBLC, but it is common for

patients to have other providers, use multiple pharmacies and

fail to volunteer information regarding over-the-counter and

alternative medicine purchases.

Results

During review of medical charts, students were able to identify

cases of drug therapy duplication and confusing or misleading

directions. These instances were brought to the attention of the

appropriate parties. Student pharmacists have also been able to

answer questions from patients about medications and discuss

dosing schedules and ways to improve adherence and reduce

undesirable side effects.

The project ran in to some challenges in implementation.

Development of the database was graciously done by a

programmer who donated his time to the project. Technical

incompatibilities caused some roadblocks that were overcome

with ingenuity and perseverance. Patients were also reluctant in

some cases to interact with students while waiting for medical

appointments. Survey return rates were low. As we continue the

project beyond the first year, we anticipate increased data and

the ability to improve our project based on concrete results.

Discussion

This project has presented both challenges and learning

opportunities. Students have benefitted from interaction with

patients, especially those with complicated regimens. Many patients

seen by the students take 15-20 medications routinely and benefit

from clearer instructions as to dose and timing of administration.

The use of our weekly calendars and medication cards can be used

as a tool to increase medication adherence for this population. We

were able to provide opportunities to the entire student body, and

incorporate 1st and 2nd year students as part of their Introductory

Pharmacy Practice Experience. The project has taught students to

recognize drugs and drug classes, pharmacological interactions and

errors, patient-specific obstacles, and enhance their relationships

with other health professionals. This experience exposed students to

the significance of medication therapy management (MTM)

services. Overall, our project has contributed to the enhancement of

the profession of pharmacy by expanding the role of pharmacists in

the healthcare system.

Future Plans

This project will be established as a permanent patient care

outreach committee within the College of Pharmacy. The project is

highly portable and ideal for including in outreach events for the

community. Customized medication lists and schedules will be

provided to patients as part of an ‘ask the expert’ or ‘brown bag’

outreach at health fairs, as well as continued targeted outreach with

underserved populations.

Prescription and non-prescription medications (supplements,

vitamins, etc.) are included, as well as patient information.

Customized dosing schedules are also provided. A variety of

colored stickers and labels are used to clarify dosing

instructions and improve adherence where appropriate. Student

pharmacists discuss regimens with patients as appropriate and

document any duplications or potential interactions. Patients

and providers were surveyed throughout the project.

Assessment forms were developed for each population to

measure the impact of the project and improve outcomes.

Methods

A database was developed that allows

students to enter and record a patient’s

medication information, either by

interviewing the patient or by reviewing

their medical chart. The project has a

laptop and printer as well as printed

materials and is very portable. Students

have provided services at several venues

including federally qualified health clinics

and a support program for patients with

mental health conditions. At events, a

customized medication list, wallet-sized

for convenient carrying, is printed and

provided to the patient.

For patients on complicated regimens, or

if needed for better readability, a full page size medication

record is provided. When the patient is not present, the

medication record is attached to the medical chart for

presentation to the patient at the next visit. When medication

regimens change, a new card may be printed for the patient.

Figure 1. Sample Medication Card

Figure 2. Sample Dosing Calendar.

Figure 3. Database Editor