COMPARISON OF PRESCRIPTION AND MEDICAL RECORDS IN REFLECTING PATIENT ANTIHYPERTENSIVE DRUG-THERAPY

OBJECTIVE: To determine the completeness of prescription records, and the extent to which they agreed with medical record drug entries for a ntihypertensive medications. SETTING: Three Clinics affiliated with tw o staff model health maintenance organizations (HMOs). PARTICIPANTS: R andomly selected HMO enrollees (n=982) with diagnosed hypertension. ME THODS: Computer-based prescription records for antihypertensive medica tions were reviewed at each location using an algorithm to convert the directions-for-use codes into an amount to be consumed per day (presc ribed daily dosage). The medical record was analyzed similarly for the presence of drug notations and directions for use. RESULTS: There was a high level of agreement between the medical record and prescription file with respect to identifying the drug prescribed by drug name. Be tween 5 and 14 percent of medical record drug entries did not have cor responding prescription records, probably reflecting patient decisions not to have prescriptions filled at HMO-affiliated pharmacies or at a ll. Further, 5-8 percent of dispensed prescription records did not hav e corresponding medical record drug entry notations, probably reflecti ng incomplete recording of drug information on the medical record. The percentage of agreement of medical records on dosage ranged from 68 t o 70 percent across two sites. Approximately 14 percent of drug record s at one location and 21 percent of records at the other had nonmatchi ng dosage information, probably reflecting dosage changes noted on the medical record but not reflected on pharmacy records. CONCLUSIONS: hi the sites studied, dispensed prescription records reasonably reflect chart drug entries for drug name, but not necessarily dosage.