Project Description
Columbia Basin Health Association (CBHA) has been providing primary health care services to rural Eastern Washington since 1972. CBHA established a community and migrant health center in Othello, located in Adams County in 1973 and in Mattawa, located in south Grant County in 1994, and acquired a second site in Othello in 2004 to better serve the residents of Othello and surrounding communities. CBHA with its 231 FTE employees in 2006 is the only provider of primary health care services for the medically indigent, and specifically the estimated 20,000 migrant and seasonal farm workers in the area, regardless of ability to pay. The mission of CBHA is to "assure equal access to quality health care to all persons regardless of age, sex, color, ethnicity, national origin, or ability to pay." In 2002, CBHA became accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). In 2006, CBHA provided 126,212 medical, mental health/substance abuses, dental and enabling encounters to 23,684 users. Migrant and Seasonal Farm Worker’s (MSFWs) represented 46% of the patients who accessed health care through CBHA during 2006.
CBHA is led by a volunteer thirteen- member consumer majority Board of Directors that includes Latinos and three MSFWs. They along with staff have helped CBHA grow into an organization integrated with state and local health care and other human services delivery systems which assures a comprehensive health care network. Employees serve in leadership roles in local, state and regional organizations to advocate for health care services for the underserved and they have been recognized for their leadership.
Columbia Basin Health Association offers comprehensive primary, preventive and enabling health care services to the medically indigent and MSFW populations within the service area. Services include medical, dental, mental health, vision, pharmacy, maternity support, outreach, case management and chronic disease management.
To comply with the Joint Commission’s 2007 National Patient Safety Goal #8 “Accurately and completely reconcile medications across the continuum of care”, Columbia Basin Health Association (CBHA) has created a new approach to medication reconciliation. Meeting this goal is critical to providing quality care. The development, reconciliation and communication of an accurate medication list throughout the continuum of care is essential in the reduction of transition-related adverse drug events.
In the past, when the patient was taken back to the exam room, the patient would be asked about the medications they were currently taking. Staff noted that many patients who are on more than one prescription could not accurately recall the names of the medications they were taking. In some cases, the patient might not even know why they were taking some medications. Still other patients would bring a large bag of medications with them, some of them expired, some not taken because of suspected adverse effects of that medication, etc.
In addition, the patient may also have medications prescribed by their specialist and often the patient would forget or omit these medications from the list, perhaps thinking that since the medication had been prescribed by a doctor other than their primary care physician, the PCP would not need to know about the medication prescribed by the specialist. Patients may also forget to tell the provider about an over the counter medication or supplement they may be taking. Omission of these drugs from the patient medication list could lead to serious medication interactions, which could result in patient illness, injury or death.
To help patients remember to tell their PCP about all the medications they are taking, CBHA staff has begun issuing Medication Totes to their patients with multiple medications. The totes are made available to the patients with instructions that the patients are to keep their medications in the totes and they are to take the tote and all medications to all doctors’ appointments, from primary care where they may be seen for a sore throat or an annual exam to their appointments with their specialists. The tote has a small pocket on the front, which is a perfect place to keep a copy of their current medication list, instructions for follow up care, or contact information for their medical provider(s).
Patients are also invited to bring their medications and medication tote to our pharmacy, where a pharmacist is able to consult with the patient regarding their medications and to provide answers to any questions the patients may have. In some cases, patients are not sure of the dosage of the medication once it has been filled, or may have questions about possible interactions that the patient did not discuss with their medical provider. These Medication Reconciliation Consultations (or “Brown Bag” consults, as they are known internally) with the pharmacist provide the perfect opportunity for the patient to discuss any medication concerns they may have, whether the questions are about new prescriptions or ongoing medication therapy. Translators are available to our Spanish speaking population so they may also have access to these consultations. In some cases, our patients have received prescription medications from Mexico. These consultations are the perfect opportunity to update the patient’s medication lists to incorporate these drugs.
Response from our patients has been very positive. Many patients bring their medications with them to each appointment, in the Medication Tote as recommended. Medical providers and nursing staff have indicated the patients are very appreciative upon receiving their tote. We have found compliance in utilization of the totes is higher in female patients; there has been some feedback from male patients that the totes “look too much like a purse” and some male patients have refused to use the totes. We are currently considering alternative options to the tote for our male patients to alleviate this issue.
We at CBHA are proud of the inroads we have made to date with this young project. We will continue to grow this program and as we do, look forward to seeing a decline in adverse drug reactions that may be directly attributable to our Medication Tote and Medication Reconciliation Consultation programs.