Class of 2007 Abstract / Objectives: Medication reconciliation is a formal process of obtaining a complete and accurate list of each patient’s current home medications. This process is done to prevent errors of omission, therapeutic duplication, dosing/frequency errors, or drug-drug/drug-disease interactions. As of January 1, 2006, University Medical Center (UMC) implemented a new, comprehensive medication reconciliation form which was intended to prevent medication-related discrepancies upon admission. The purpose of this study was to compare the percent of missing required prescription information upon hospital admission before and after the implementation of the medication reconciliation form. Methods: This study was an inferential retrospective chart review of patients admitted to UMC in Tucson, Arizona, between January 1, 2005 and August 1, 2006. While the overall goal was to measure the impact of a new medication reconciliation form on the completeness of a patient's medication history, the specific study objectives were to: (1) evaluate medication reconciliation form utilization and compliance and (2) compare the completeness of medication information upon hospital admission before and after the implementation of the comprehensive medication reconciliation form. Patients were included in the study if they were over 18 years of age and admitted to UMC at least once in 2005, and at least once between January 1, 2006 and August 1, 2006. The following patients were excluded: patients that were institutionalized in an assisted living facility or nursing home, admitted to the emergency room, intubated, transferred to the hospital from a nursing home or a long term care facility, and discharged from the hospital within 24 hours of admit. Two hundred and thirty-four patients, who met the inclusion criteria, were randomly selected from a UMC hospital census. The researchers reviewed each medical chart and recorded the physician-reported medication history, reason for admit, length of stay, and demographic information. Descriptive and inferential statistical analysis was completed using SPSS Version 11.0 (SPSS Inc., Chicago, IL). After collecting the data, counts were taken on missing prescription information, such as missing medication names, dose, route, and frequencies. If the collected data were normally distributed and were interval/ratio level data, a paired t- test was used for analysis. If the data were not normally distributed or were of nominal/ordinal level, a McNemar test was used. An a priori alpha level of 0.05 was used for all statistical tests. Results: A total of 234 patients were included in both the pre and post analysis. Approximately 53.8% of the sample was male. Fifty-one percent of the population was categorized as white in the patient’s chart. The average age at time of first admit was 50.3 years. Fifty-three percent of the population had a past medical history that included cardiovascular disease. Over 28% of the patients in the sample had diabetes and over 18% had pulmonary disease. The most common admit diagnoses for the population included shortness of breath, chest pain, and abdominal pain. Medication reconciliation forms were found in the chart 71.4% of the time. Of the 71.4% of the forms present in the patient’s medical chart, the form was utilized 66.6% of the time. The percentage of allergies recorded in the patient’s chart decreased from 89.3% before implementation of the form to 65.9% after implementation. This movement repeated itself with the recording of social history, which fell from 92.3% recorded before the form to 52.6% after implementation. Introduction of the new medication reconciliation form at UMC resulted in significantly fewer drug names missing, incorrect, or illegible from the patient’s medication history between pre and post (p=0.034), as well as a greater amount of medications recorded in the patient’s medication history (p=0.006). However, the use of the form did not result in significant differences between pre and post in the route, frequency, and dosing information being recorded. It also did not result in a significantly greater amount of non- prescription drugs recorded. Conclusions: The results of this study indicate the need for a systematic approach to ensure the process of obtaining accurate medication histories at the time of hospital admission. Utilization of a new comprehensive medication reconciliation form in this academic institution is far from optimal, and could have significant healthcare implications. Better methods of ensuring medication reconciliation at the time of hospital admission are needed.

The present research program was designed as an empirical investigation ofRelational Discrepancy Theory (RDT; Robins & Boldero, 2003). RDT proposes thatperceptions of discrepancies between relationship partners with respect to sharedaspirations and obligations (i.e., ideal and ought relational guides) have negativeemotional and relationship functioning consequences. Two kinds of relationaldiscrepancy are described: relational-guide discrepancies, which arise from theperception that one partner has more ambitious or demanding relational guides thanthe other; and relational-actual discrepancies, which arise from the perception that onepartner is actually better at meeting relational guides than the other. The fourempirical studies presented in this dissertation investigate the previously untestedpredictions of RDT regarding the impact of both kinds of discrepancies on closeness,conflict, disapproval of partners, and admiration of partners.

The ability to effectively regulate one’s emotions has been linked with many aspects of well-being. However, disagreement in parents’ and children’s reports of children’s emotion regulation presents significant measurement and conceptual challenges. This investigation aimed to identify predictors of these discrepancies from among demographic, psychopathology, and child emotional awareness measures and to examine patterns of discrepancies among three emotion types (i.e., anger, sadness, and worry) and three regulation “strategies” (i.e., inhibition, dysregulated expression, and coping). Sixty-one mother-child dyads (41 girls, mean age 9.3 years) participated. As hypothesized, age, child and parent report of psychopathology, and poor emotion awareness all emerged as significant predictors of discrepancy. Additionally, discrepancies for inhibition subscales across all three emotions were of a larger magnitude than the other subscales; the effect was more pronounced for sadness than worry. Overall, the findings suggest patterns of disagreements are not random but rather may provide unique information that could elucidate relations among emotion regulation, psychopathology, and other indices of functioning.

Discrepancy in reporting is a frequent phenomenon in psychotherapy research and its presence indicates added information to take into account when assessing youth functioning (De Los Reyes, 2011; Hawley & Weisz, 2003). There is a need to further understand patterns in youth psychotherapy to protect from risk of treatment failure or deterioration. Our study aimed to explore informant discrepancy and its relation to key therapeutic constructs as well as youth functionality over time within youth outpatient mental health populations who use the Y-OQ and TSM in routine outcome monitoring and as clinical support measures. Using an outpatient mental health sample, regular Y-OQ and TSM data from n=157 youth ages 12-18 and their primary caregivers was assessed. Informant discrepancy was measured using initial total Y-OQ scores from both the youth and primary caregiver. Therapeutic constructs were measured using the TSM domains of primary caregiver distress, therapeutic alliance, and youth motivation. Change in functioning throughout the course of treatment was measured by the primary caregiver and youth Y-OQ total scores at each session. Results indicated that informant discrepancy predicted primary caregiver distress as well as change in youth functioning over time as perceived by the primary caregiver. Consistent with previous research, higher discrepancy between was associated with higher primary caregiver distress and predicted poorer youth functioning throughout the course of treatment. Implications and conclusions are discussed.

Internalizing disorders are prevalent among youth. However, disagreements exist between parents’ and youth’s reports of mental health symptoms. In particular, youth-onset internalizing disorders such as depression and anxiety have been shown to have the highest reporter discrepancies amongst all disorders. In this study we examined what may contribute to these discrepancies by examining the moderating role of family functioning in a sample of 456 parent-adolescent dyads. Results indicated that although discrepancies did exist between parent and adolescent (M age = 14.97 years; SD = 0.33 years) reports of both anxiety and depression, family functioning did not significantly moderate these discrepancies. The results of this study provide further knowledge on the subject of youth mental health by establishing the presence of parent-adolescent report discrepancies.

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Parental influence on college students' well being is underestimated frequently in the developmental literature. College students often set social and academic goals according to their perception of what their parents expect from them. The discrepancy between college students' performance and their perceptions of parents' expectations can impact their quality of life. The purpose of this study was to examine various parent-college student expectation discrepancies and communication levels as predictors for college students' psychological well being. Results revealed that college students reported experiencing higher levels of anger, depression, and anxiety and lower levels of self-esteem and college adjustment when higher expectation-performance discrepancies were present. Results also indicated that a higher perceived level of communication, particularly by the college student, served as a predictor of distress and was related to lower levels of affective distress and higher levels of self-esteem and college adjustment. Such findings underscore the importance of teaching assertive communication skills to college students and their parents as a means of diminishing the deleterious effects of perceiving one another inaccurately.

No / Many studies have highlighted the problems associated with different aspects of medicines reconciliation (MR). These have been followed by numerous recommendations of good practice shown in published studies to decrease error; however, there is little to suggest that practice has significantly changed. The study reported here was conducted to review local medicines reconciliation practice and compare it to data within previously published evidence. To determine current medicines reconciliation practice in four acute hospitals (A–D) in one region of the United Kingdom and compare it to published best practices. Quantitative data on key indicators were collected prospectively from medical wards in the four hospitals using a proforma compiled from existing literature and previous, validated audits. Data were collected on: i) time between admission and MR being undertaken; ii) time to conduct MR; iii) number and type of sources used to ascertain current medication; and iv) number, type and potential severity of unintended discrepancies. The potential severity of the discrepancies was retrospectively dually rated in 10% of the sample using a professional panel. Of the 250 charts reviewed (54 Hospital A, 61 Hospital B, 69 Hospital C, 66 Hospital D), 37.6% (92/245) of patients experienced at least one discrepancy on their drug chart, with the majority of these being omissions (237/413, 57.1%). A total of 413 discrepancies were discovered, an overall mean of 1.69 (413/245) discrepancies per patient. The number of sources used to reconcile medicines varied with 36.8% (91/247) only using one source of information and the patient being used as a source in less than half of all medicines reconciliations (45.7%, 113/247). In three out of the four hospitals the discrepancies were most frequently categorized as potentially requiring increased monitoring or intervention. This study shows higher rates of unintended discrepancies per patient than those in previous studies, with omission being the most frequently occurring type of discrepancy. None of the four centers adhered to current UK guidance on medicines reconciliation. All four centers demonstrated a strong reliance on General Practitioner (GP)-based sources. A minority of discrepancies had the potential to cause injury to patients and to increase utilization of health care resources. There is a need to review current practice and procedures at transitions in care to improve the accuracy of medication history-taking at admission by doctors and to encourage pharmacy staff to use an increased number of sources to validate the medication history. Although early research indicates that safety can be improved through patient involvement, this study found that patients were not involved in the majority of reconciliation encounters.