TY - JOUR
T1 - Electronic health record-based strategy to promote medication adherence among patients with diabetes
T2 - Longitudinal observational study
AU - Bailey, Stacy Cooper
AU - Wallia, Amisha
AU - Wright, Sarah
AU - Wismer, Guisselle A.
AU - Infanzon, Alexandra C.
AU - Curtis, Laura M.
AU - Brokenshire, Samantha A.
AU - Chung, Arlene E.
AU - Reuland, Daniel S.
AU - Hahr, Allison J.
AU - Hornbuckle, Kenneth
AU - Lockwood, Karen
AU - Hall, Lori
AU - Wolf, Michael S.
N1 - Funding Information:
This study was funded by Eli Lilly and Company. Authors include employees of Eli Lilly and Company.
Publisher Copyright:
© Stacy Cooper C Bailey, Amisha Wallia, Sarah Wright, Guisselle A Wismer, Alexandra C Infanzon, Laura M Curtis, Samantha A Brokenshire, Arlene E Chung, Daniel S Reuland, Allison J Hahr, Kenneth Hornbuckle, Karen Lockwood, Lori Hall, Michael S Wolf.
PY - 2019/10
Y1 - 2019/10
N2 - 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.
AB - 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.
KW - Clinical decision support
KW - Health literacy
KW - Medication adherence
KW - Patient portal
UR - http://www.scopus.com/inward/record.url?scp=85073656724&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85073656724&partnerID=8YFLogxK
U2 - 10.2196/13499
DO - 10.2196/13499
M3 - Article
C2 - 31638592
AN - SCOPUS:85073656724
SN - 1439-4456
VL - 21
JO - Journal of medical Internet research
JF - Journal of medical Internet research
IS - 10
M1 - e13499
ER -
