Integration of Provider, Pharmacy, and Patient-Reported Data to Improve Medication Adherence for Type 2 Diabetes: A Controlled Before-After Pilot Study.
Integration of Provider, Pharmacy, and Patient-Reported Data to Improve Medication Adherence for Type 2 Diabetes: A Controlled Before-After Pilot Study.
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DOI：
10.2196/medinform.4739
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发表时间：
2016-02-08
影响因子：
3.2
通讯作者：
Marrero DG
中科院分区：
文献类型：
--
作者：
Dixon BE;Alzeer AH;Phillips EO;Marrero DG
糖尿病患者通常对按处方服药的依从性很差。然而，原因并不是很清楚。此外，大多数医疗保健提供过程不会定期评估服药依从性或导致依从性差的因素。这项研究的目的是评估综合信息学方法的可行性，以汇总和显示临床相关数据，并有可能识别可能干扰适当用药的问题，并在临床会面期间促进患者与提供者就改善用药策略进行沟通。我们在电子健康记录(EHR)系统中开发了一个临床仪表板，它使用来自三个来源的数据：医疗记录、药房索赔和患者门户。接下来，我们将仪表板应用到三个社区卫生中心。卫生保健提供者(n=15)和糖尿病患者(n=96)参加了前后试点，以测试该系统对服药依从性和临床结果的影响。为了衡量依从性，我们使用药房索赔计算了覆盖天数的比例。使用配对t检验分析来自EHR的人口统计学、实验室和访问数据。患者自我报告了对坚持的感知障碍。对供应商进行了关于他们对临床仪表板的使用和看法的调查。在糖尿病和心血管药物类别中，依从性显著和有意义地提高(改善幅度在6%-20%之间)。临床结果，包括糖化血红蛋白、血压、血脂控制和急诊科使用情况保持不变。只有四分之一的患者(n=24)登录到患者门户网站，并完成了关于他们服药障碍的心理社会问卷。使用先进的电子病历、临床决策支持和患者控制技术的综合方法显示出改善适当用药和支持更好地管理慢性病的前景。未来的研究和开发是必要的，以设计、实施和集成无数的电子病历和临床决策支持系统，以及以患者为中心的信息系统，将其纳入共同支持健康和福祉的常规护理和患者流程。
Patients with diabetes often have poor adherence to using medications as prescribed. The reasons why, however, are not well understood. Furthermore, most health care delivery processes do not routinely assess medication adherence or the factors that contribute to poor adherence. The objective of the study was to assess the feasibility of an integrated informatics approach to aggregating and displaying clinically relevant data with the potential to identify issues that may interfere with appropriate medication utilization and facilitate patient-provider communication during clinical encounters about strategies to improve medication use. We developed a clinical dashboard within an electronic health record (EHR) system that uses data from three sources: the medical record, pharmacy claims, and a patient portal. Next, we implemented the dashboard into three community health centers. Health care providers (n=15) and patients with diabetes (n=96) were enrolled in a before-after pilot to test the system’s impact on medication adherence and clinical outcomes. To measure adherence, we calculated the proportion of days covered using pharmacy claims. Demographic, laboratory, and visit data from the EHR were analyzed using pairwise t tests. Perceived barriers to adherence were self-reported by patients. Providers were surveyed about their use and perceptions of the clinical dashboard. Adherence significantly and meaningfully improved (improvements ranged from 6%-20%) consistently across diabetes as well as cardiovascular drug classes. Clinical outcomes, including HbA1c, blood pressure, lipid control, and emergency department utilization remained unchanged. Only a quarter of patients (n=24) logged into the patient portal and completed psychosocial questionnaires about their barriers to taking medications. Integrated approaches using advanced EHR, clinical decision support, and patient-controlled technologies show promise for improving appropriate medication use and supporting better management of chronic conditions. Future research and development is necessary to design, implement, and integrate the myriad of EHR and clinical decision support systems as well as patient-focused information systems into routine care and patient processes that together support health and well-being.