Electronic health record-based medication monitoring improves patient compliance in primary care clinics
Toxicity-related adverse drug events (ADEs) are significant both for the direct harm they cause and the indirect effects they may have on patients' compliance with medications. Prevention of ADEs associated with medication toxicity depends, in part, on conscientious medication monitoring. Yet a new study by a team of Baltimore, Maryland researchers found that two in five patients at two federally qualified health centers (FQHCs) were overdue for laboratory monitoring of medications during a 12-month period.
The patients were taking digoxin, statins, diuretics, and angiotensin-converting enzyme inhibitors/angiotensin II-receptor blockers. As the number of index medications the patient was prescribed increased, the likelihood of ever being overdue for monitoring decreased. To monitor patients' medication compliance, analysts from each health center used an automated, electronic health record (EHR)-derived algorithm to identify patients taking one or more of the reference medications who were overdue for recommended laboratory monitoring.
Every 1 to 2 months during the 1-year study, providers were sent a paper-based medication monitoring bulletin that included a summary of the monitoring recommendations, a list of the provider's overdue patients, and a graphical summary of each provider's individual performance. Being listed on a provider-specific monitoring bulletin doubled the odds of a patient receiving recommended laboratory monitoring before the next measurement period (1-2 months later).
The researchers concluded that provider-specific feedback reports increased the likelihood that identified patients would subsequently receive recommended monitoring. The researchers noted that although EHRs may be an important component of systems designed to improve medication monitoring, multimodal interventions will likely be needed to achieve greater reliability.
The 2,013 patients included in the study were being treated at two FQHCs in Baltimore with drugs for which the National Committee for Quality Assurance had established monitoring guidelines. This study was supported in part by the Agency for Healthcare Research and Quality (HS17018).
See "Electronic health record-based monitoring of primary care patients at risk of medication-related toxicity" by David G. Bundy, MD, Jill A. Marsteller, PhD, Albert W. Wu, MD, and others in the May 2012 Joint Commission Journal on Quality and Patient Safety 38(5), pp. 216-223.
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