Efforts to encourage patients to create a personal list of currently used medications illustrate that it can be difficult to get people to do what they know is good for them.

"Most people are aware of the fact that it's a good idea to carry a list," said Mike D. Sanborn, corporate director of pharmacy at Baylor Health Care System in Dallas, which has conducted two informal community surveys about personal medication records.

In all, he said, about two thirds of some 250 people surveyed were taking at least one medication, but fewer than half of them kept the medication information with them on some kind of list. When participants were asked about the value of creating a medication list, Sanborn said, "their response is that they know that they should, but they don't - kind of like [saying] I know I should wear my seat belt, but I don't."

The surveys were conducted for "Educate Before You Medicate," a program sponsored by the Dallas - Fort Worth Hospital Council. The program, which began last year, provides patients with standardized forms and wallet cards on which to list current medications and other important medical information. Residents are advised to keep the records with them at all times in case of an emergency and for use during routine medical encounters.

"Many of the hospitals report seeing these cards in patients that present to the hospital," Sanborn said. "So we know there is some uptake."

Jeanne Ezell, director of pharmacy at Blount Memorial Hospital in Maryville, Tennessee, and a past president of the Tennessee Society of Health-System Pharmacists, speculated that patients have not yet embraced personal health records because health care providers have not emphasized the need to do so.

"I think that's partly a failing of health care providers-the physicians and nurses and pharmacists," Ezell said. "We've not said, 'When you come to the hospital, bring that list with you.'"

She noted that patients know to bring their insurance card with them to receive care. "If we had the same level of expectation that I'm not going see you unless you've got your list of medications with you, then people would adopt it real quick," she said.

Working with the Tennessee Pharmacists Association, Ezell was a driving force behind last year's statewide launch of the Universal Medication List, a standardized form for listing patients' medications and medical history.

Ezell said she and another pharmacist promoted the medication list during National Patient Safety Awareness Week, which takes place each year in early March.

The two pharmacists asked people coming into the hospital whether they took any medications and carried a list of those medications. "Some of them whipped it out," Ezell said. "Some of the lists were just the drug name et cetera. So we gave them a little bit of feedback and gave them one of our forms and encouraged them to use it."

Ezell said she is also asking community pharmacists in Tennessee to help patients start a medication list.

Most pharmacy systems in community pharmacies, Ezell said, can print a list of a patient's medications, the quantity dispensed, and the date of dispensing. But that type of list is for insurance purposes and is inadequate as a medication list, she said. So Ezell is encouraging community pharmacists to change the format of those printouts or provide blank forms for patients' use.

Tennessee's medication form is modeled after one created by the South Carolina Hospital Association, as is a similar form dubbed My Medicine List that is being used statewide in Minnesota.

Minnesota's campaign is coordinated by the Minnesota Alliance for Patient Safety, and the program's partners include Allina Hospitals and Clinics and Fairview Health Services, both headquartered in Minneapolis. Jill M. Strykowski, director of pharmacy at Allina's Mercy and Unity Hospitals, said the alliance has been working for about two years to publicize My Medicine List to patients and health care providers, including pharmacists in the state.

"What surprised me pleasantly in speaking to my pharmacy colleagues, whether in the retail, clinic, or hospital setting, was universal acceptance that this was something that was desperately needed," she said.

At Mercy and Unity, an electronic version of My Medicine List has been integrated into the hospitals' medication reconciliation process, which produces records required by the hospital and the Joint Commission as well as a paper copy for patients to keep with them.

Strykowski plans to train emergency department (ED) pharmacists to keep track of the number of completed My Medicine List forms that patients bring into the hospitals. Ezell said she is working on a similar project with an ED pharmacist at her Tennessee hospital.

Some institutions are not waiting for state or regional programs to promote personal medication records but are moving ahead on their own.

Tim R. Brown, director of clinical pharmacotherapy at the Akron General Center for Family Medicine in Ohio, works in a family practice office that employs a medical assistant to sit in the lobby and help patients fill out a medication record as part of the office visit. Since August, Brown has had pharmacy students work with the medical assistant to help patients complete their medication lists.

Brown said the medication record initiative was motivated both by the Joint Commission's medication reconciliation requirements and an upcoming institutional switch to electronic health records. He noted that preappointment telephone reminders to patients include instructions for them to bring all of their medications to the appointment so that the records can be kept current.

David Gammon, clinical pharmacist at the UMass Memorial Hospital University Campus in Worcester, Massachusetts, said blank personal medication records are provided to patients who undergo bone marrow transplantation at the medical center. During the discharge process, which includes counseling from an oncology pharmacist and the creation of a customized monograph of discharge medications, patients are given a medication card to complete when they get home and asked to carry the document with them whenever they leave the house.

But Steven Meisel, director of medication safety at Fairview Health Services in Minneapolis, illustrated a surprising barrier to the adoption of personal medication records.

During a recent meeting of about a dozen hospital administrators, Meisel said, he asked the attendees if they had in their wallet a completed version of My Medicine List. "Nobody other than me raised their hand," Meisel said. "I said, 'Therein lies the issue. Until you as providers and leaders internalize it in terms of your personal behaviors . . . we're not going to get traction in the community.'"