Electronic health records and the digital tools that give doctors and patients access to their healthcare information apparently aren’t doing an adequate job helping to improve care among the chronically ill once they’re home and on multiple medications.
That’s the main takeaway from a new study by researchers from Northwestern University in Chicago. In fact, giving patients tools via electronic health records to help them manage taking complex drugs didn’t improve medication adherence or lower blood pressure, the study says. “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.”
Northwestern researchers evaluated providing patients with medication management tools—such as printed medication lists at each visit and information sheets in lay language—via an electronic health records system, which would be less costly than individualized attention from clinicians, Northwestern says.
Researchers investigated if electronic tools would improve medication reconciliation, understanding and adherence, as well as lower systolic blood pressure among patients with complex drug regimens and hypertension.
Northwestern researchers conducted a clinical trial at 12 Chicago health centers for 794 patients with hypertension who were taking three or more medications at once. One group of patients received just electronic tools while a second group received the electronic health records tools and a nurse-led educational counseling session. A third group received usual care.
Patients taking multiple pills improved in the two groups with electronic tools compared with usual care, and in the group that received nurse education, patients also showed improved understanding of following directions and taking the right dose, Northwestern says.
Patients with chronic health conditions often require complex drug regimens, which can be challenging to manage and can lead to medication errors with patients not taking their medicine on time or in the right amount. The problem is particularly prevalent among patients with low health literacy, researchers say.
But while the Northwestern researchers found that increased use of electronic health records resulted in patients better understanding the medications they are on, access to the tools alone didn’t result in continued use at home or improving their conditions. In fact, researchers said they saw no improvement in most patients lowering high blood pressure—even with access to digital monitoring tools at home. In fact, blood pressure worsened in the EHR-only group, researchers say. Researchers aren’t sure what accounted for no significant improvement in patients lowering high blood pressure 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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