Electronic Health Record-Based Strategy to Promote Medication Adherence Among Patients With Diabetes: Longitudinal Observational Study
Electronic Health Record-Based Strategy to Promote Medication Adherence Among Patients With Diabetes: Longitudinal Observational Study
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DOI：
10.2196/13499
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发表时间：
2019-10-21
影响因子：
7.4
通讯作者：
Wolf, Michael S.
中科院分区：
文献类型：
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作者：
Bailey, Stacy Cooper;Wallia, Amisha;Wolf, Michael S.
背景：药物依从性差是常见的；然而，在临床实践中，很少有机制存在，以监测患者如何服用药物在门诊设置。目的：本研究旨在试点测试电子药物完整通信（EMC2）策略，这是一种低成本、可持续的方法，利用电子健康记录中的功能来促进门诊药物依从性和安全性。方法：在2个学术实践中对14种高危糖尿病药物实施EMC2策略。该策略包括：(1)临床决策支持警报，以提示提供者对药物风险进行咨询；(2)低识字率患者的药物摘要；(3)基于门户网站的问卷调查，以监测门诊药物使用情况；(4)针对已确定的问题进行临床外展。我们招募了患有糖尿病的成年患者，他们被开了高风险的糖尿病药物。参与者完成了基线和2周的访谈，以评估对干预成分的接受和满意度。结果：共纳入100例患者；90人完成了为期两周的访谈。患者种族多样化，30.0%（30/100）为高中以下学历，40.0%（40/100）为有限的读写能力。约四分之一（28/100）没有门户网站帐户；在收入和教育程度不同的账户拥有率方面，人们注意到了社会经济差异。在有门户账户的患者中，58%（42/72）完成了问卷调查；42例患者中有21例报告了需要临床随访的担忧。其中，诊所联系了17人，或在24小时内解决了他们的问题。大多数完成门户调查问卷和随访访谈的患者（33/ 38,89%）报告了高水平的满意度（在1-10的量表中得分为8或更高）。结论：研究结果表明，EMC2策略可以可靠地实施并交付给患者，并具有高水平的满意度。门户使用的差异可能会限制干预的范围。尽管EMC2策略可以在对临床工作流程影响最小的情况下实施，但需要未来的试验来评估其有效性，以促进依从性和安全性。
Background: Poor medication adherence is common; however, few mechanisms exist in clinical practice to monitor how patients take medications in outpatient settings.Objective: This study aimed to pilot test the Electronic Medication Complete Communication (EMC2) strategy, a low-cost, sustainable approach that uses functionalities within the electronic health record to promote outpatient medication adherence and safety.Methods: The EMC2 strategy was implemented in 2 academic practices for 14 higher-risk diabetes medications. The strategy included: (1) clinical decision support alerts to prompt provider counseling on medication risks, (2) low-literacy medication summaries for patients, (3) a portal-based questionnaire to monitor outpatient medication use, and (4) clinical outreach for identified concerns. We recruited adult patients with diabetes who were prescribed a higher-risk diabetes medication. Participants completed baseline and 2-week interviews to assess receipt of, and satisfaction with, intervention components.Results: A total of 100 patients were enrolled; 90 completed the 2-week interview. Patients were racially diverse, 30.0% (30/100) had a high school education or less, and 40.0% (40/100) had limited literacy skills. About a quarter (28/100) did not have a portal account; socioeconomic disparities were noted in account ownership by income and education. Among patients with a portal account, 58% (42/72) completed the questionnaire; 21 of the 42 patients reported concerns warranting clinical follow-up. Of these, 17 were contacted by the clinic or had their issue resolved within 24 hours. Most patients (33/38, 89%) who completed the portal questionnaire and follow-up interview reported high levels of satisfaction (score of 8 or greater on a scale of 1-10).Conclusions: Findings suggest that the EMC2 strategy can be reliably implemented and delivered to patients, with high levels of satisfaction. Disparities in portal use may restrict intervention reach. Although the EMC2 strategy can be implemented with minimal impact on clinic workflow, future trials are needed to evaluate its effectiveness to promote adherence and safety.