Research Activities, August 2013
Automated phone monitoring system provides important information about medication discontinuation
Patient Safety and Quality
Interactive voice response system (IVRS) technology has the potential to directly contact large numbers of patients to assess their adherence to their medication regimen, as well as symptoms experienced while taking the medication. A new study found that rates at which patients reported by phone their discontinuation of medication were substantially higher than those documented in the electronic medical record. This suggests that the IVRS may be an important tool for improving physician-patient communication about medication adherence, note the researchers.
Over 1,500 patients from 11 primary care clinics affiliated with the Brigham and Women’s Hospital agreed to receive an e-pharmacovigilance call that used IVRS. Overall, 3.9 percent of patients who completed the e-pharmacovigilance call and 1.0 percent of patients who did not complete the call had discontinuation of the target medication recorded in the electronic medical record within 6 months of their eligibility date.
This difference was statistically significant. Those who completed the call also had higher use of primary or specialty care (32.8 percent) than those who did not complete the call (18.7 percent). The rates of other outcomes (acute care services and death) were similar in both groups (12.2 and 9.8 percent).
Each patient had recently been started on one of 32 medications selected for the study. Four weeks after a primary care visit, patients received an e-pharmacovigilance call (i.e., a telephone call using IVRS) about whether they were still taking the medication recently prescribed and, if they had stopped, why? Following the call, the system sent a single Email to the primary care provider if the patient:
- Reported stopping a medication intended for chronic use and indicated that they had not discussed this with their provider.
- Reported a pre-defined list of symptoms.
- Requested that an Email be sent to the provider.
Among the subgroup of 799 participants who noted at least one symptom, 176 (22 percent) attributed their symptom to the medication. Patients who thought that their symptom was related to the medication were more likely to report that they had stopped the medication (13.1 percent) compared with those who did not think that the symptom was related to the medication (1.5 percent). This study was supported by AHRQ (HS16970).
See "Active pharmacovigilance and healthcare utilization," by Jennifer S. Haas, M.D., Elissa Klinger, S.M., Lucas Xavier Marinacci, B.A., and others in the November 2012 American Journal of Managed Care 18(11), pp. e423-e428.