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Tools in e-records fail to help patients on lots of meds

Giving patients tools via electronic health records to help them manage complex drug regimens didn’t improve medication adherence or lower blood pressure, a new study reports.

“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,” says Stephen Persell, associate professor of medicine in the general internal medicine and geriatrics division at Northwestern University.

“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, researchers say.

Take-home lists

For the new study, which appears in the Journal of the American Medical Association, investigators evaluated providing patients with medication management tools—such as printed medication lists at each visit and information sheets in lay language—via 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 within the Access Community Health Network in the Chicago area, included 794 patients with hypertension who were taking three or more medications at once.

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.

Unexpected results

Medication reconciliation improved in both intervention groups compared to usual care, and in the group that received nurse education, patients also showed improved understanding of medication instructions and dosing.

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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.

Researchers aren’t sure what contributed to these unexpected findings, but they 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.

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The study highlights the importance of testing system-level changes for unintended effects, the authors say.

“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,” Persell says.

The National Institute of Nursing Research, National Institutes of Health funded the work.

Source: Northwestern University

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