Tools delivered through an electronic health record (EHR) to help patients manage complex drug regimens failed to improve medication adherence or lower blood pressure among patients with hypertension, according to a Northwestern Medicine study published in JAMA Internal Medicine.
“We are increasingly asking patients to do very complicated things with medications, and we don’t always build effective ways to support their successful use of medications,” said first author Dr. Stephen Persell, director of the Center for Primary Care Innovation of the Institute for Public Health and Medicine (IPHAM) at Northwestern. “We have to keep trying out new ways to better support patient medication self-management and make the path easier for patients.”
Patients with chronic health conditions often require complex drug regimens, which can be challenging to manage and can lead to non-adherence and medication errors. The problem is particularly prevalent among patients with low health literacy.
In the current study, the investigators evaluated providing patients with medication management tools — such as printed medication lists at each visit and information sheets in lay language — delivered through an EHR, which would be less costly than individualized attention from clinicians.
The investigators hypothesized that the tools would improve medication reconciliation, understanding and adherence, as well as lower systolic blood pressure among patients with complex drug regimens and hypertension.
The randomized clinical trial, conducted at 12 federally qualified health centers (FQHCs) within the Access Community Health Network in the Chicago area, included 794 patients with hypertension who were taking three or more medications at once.
In the study, one group of patients received the EHR tools alone, a second received the EHR tools plus a nurse-led educational intervention, and a third group received usual care.
The investigators found that medication reconciliation was improved in both intervention groups compared to usual care, and in the group that also received nurse education, patients also showed improved understanding of medication instructions and dosing.
However, the interventions had no significant effect on patients’ self-reported medication adherence. Furthermore, there was no significant effect on blood pressure in the EHR tools plus nurse education group — and in fact, blood pressure worsened in the EHR-alone intervention group.
While it’s unclear what contributed to these unexpected findings, the authors note that the medication information sheets (which contain information about adverse drug effects), may have led some patients to stop or reduce anti-hypertension medications, when used without the addition of individualized counseling from a healthcare professional.
The study highlights the importance of testing system-level changes for unintended effects, the authors said. “When you do clinic-level interventions, it’s very important to test in a robust way, so that you can detect potentially positive and negative consequences of what you’re doing,” said Dr. Persell, also associate professor of medicine in the division of general internal medicine and geriatrics.
Dr. Persell notes that there are a number of ongoing investigations at Northwestern evaluating new strategies to support medication self-management, including by Dr. Michael Wolf, associate vice chair for research in the department of medicine and a professor of medical social sciences.
“There is a huge amount of growth happening in mobile technology,” Dr. Persell said. “How that helps us support patients’ self-management is going to be a really exciting area in the future.”
The study was supported by award R01NR012745 from the National Institute of Nursing Research, National Institutes of Health.