In the Journals

EHR tools confer improved medication reconciliation but worse BP

Patients who received care in community health centers that utilized electronic health record tools had improved medication reconciliation and worsened BP compared with those who received usual care, according to a study published in JAMA Internal Medicine.

When nurse-led support was added, understanding of medication instructions and dosing improved with no effect on BP vs. usual care.

“Even with the combined intervention, self-administration errors, medication discrepancies and incomplete adherence were common, leaving much room for improvement,” Stephen D. Persell, MD, MPH, associate professor of medicine in the division of general internal medicine and geriatrics at Northwestern University Feinberg School of Medicine, and colleagues wrote.

Centers in Chicago

Researchers analyzed data from 794 participants (mean age, 53 years; 69% women) with hypertension who received care from community health centers in Chicago and reported using three or more medications for any purpose. Participants were treated at the centers from April 30, 2012, to Feb. 29, 2016.

The centers were assigned into three groups: EHR-based medication management with nurse-led education and support, EHR-based medication management alone or usual care. Tools integrated within EHR included printouts of medication lists, instructions and content appropriate from a patient’s perspective. Nurses who were added to the group assigned that intervention identified areas for monitoring and follow-up and provided medication counseling. They also assessed medication use, comprehension, reconciliation and adherence.

Participants were assessed at baseline, 3, 6 and 12 months to collect information on health conditions, sociodemographic characteristics, participant-reported outcomes, health literacy, knowledge of medication indication, medication reconciliation, medication adherence and health-related quality of life.

The primary outcome was systolic BP. Participants underwent the intervention for 1 year.

Effects on BP

At 12 months, participants in the EHR-alone group had a higher systolic BP compared with those who received usual care (adjusted mean difference = 3.6 mm Hg; 95% CI, 0.3-6.9). Systolic BP was not significantly lower in the group that received EHR plus education compared with usual care (adjusted mean difference = –2 mm Hg; 95% CI, –5.2 to 1.3), but it was lower vs. those who received EHR alone (–5.6 mm Hg; 95% CI, –8.8 to –2.4).

Compared with usual care, medication reconciliation was improved in both the EHR-alone group (aOR = 1.8; 95% CI, 1.1-2.9) and the EHR-plus-education group (aOR = 2; 95% CI, 1.3-3.3).

Participants who were treated at centers assigned EHR plus education had a greater understanding of medication instructions and dosing compared with usual care for hypertension medications (OR = 2.3; 95% CI, 1.1-4.8) and all medications combined (OR = 1.7; 95% CI, 1-2.8).

Hypertension medication adherence did not improve in centers assigned EHR tools alone or with education compared with usual care (OR = 0.9; 95% CI, 0.6-1.4 for both). This was also seen for knowledge of chronic drug indications in centers assigned EHR tools alone (OR = 1; 95% CI, 0.6-1.5) or EHR plus education (OR = 1.1; 95% CI, 0.7-1.7) vs. the usual care.

“The finding of higher blood pressure among the group that received EHR tools alone was unexpected,” Persell and colleagues wrote. “We speculate that medication information sheets (which contain some information on adverse drug effects) may have led some patients to stop or reduce antihypertensive therapy. Medication review may have uncovered some cases where individuals were using duplicate medications.” – by Darlene Dobkowski

Disclosures: Persell reports he received unrelated research support from Omron Healthcare Co. and Pfizer. The other authors report no relevant financial disclosures.

Patients who received care in community health centers that utilized electronic health record tools had improved medication reconciliation and worsened BP compared with those who received usual care, according to a study published in JAMA Internal Medicine.

When nurse-led support was added, understanding of medication instructions and dosing improved with no effect on BP vs. usual care.

“Even with the combined intervention, self-administration errors, medication discrepancies and incomplete adherence were common, leaving much room for improvement,” Stephen D. Persell, MD, MPH, associate professor of medicine in the division of general internal medicine and geriatrics at Northwestern University Feinberg School of Medicine, and colleagues wrote.

Centers in Chicago

Researchers analyzed data from 794 participants (mean age, 53 years; 69% women) with hypertension who received care from community health centers in Chicago and reported using three or more medications for any purpose. Participants were treated at the centers from April 30, 2012, to Feb. 29, 2016.

The centers were assigned into three groups: EHR-based medication management with nurse-led education and support, EHR-based medication management alone or usual care. Tools integrated within EHR included printouts of medication lists, instructions and content appropriate from a patient’s perspective. Nurses who were added to the group assigned that intervention identified areas for monitoring and follow-up and provided medication counseling. They also assessed medication use, comprehension, reconciliation and adherence.

Participants were assessed at baseline, 3, 6 and 12 months to collect information on health conditions, sociodemographic characteristics, participant-reported outcomes, health literacy, knowledge of medication indication, medication reconciliation, medication adherence and health-related quality of life.

The primary outcome was systolic BP. Participants underwent the intervention for 1 year.

Effects on BP

At 12 months, participants in the EHR-alone group had a higher systolic BP compared with those who received usual care (adjusted mean difference = 3.6 mm Hg; 95% CI, 0.3-6.9). Systolic BP was not significantly lower in the group that received EHR plus education compared with usual care (adjusted mean difference = –2 mm Hg; 95% CI, –5.2 to 1.3), but it was lower vs. those who received EHR alone (–5.6 mm Hg; 95% CI, –8.8 to –2.4).

Compared with usual care, medication reconciliation was improved in both the EHR-alone group (aOR = 1.8; 95% CI, 1.1-2.9) and the EHR-plus-education group (aOR = 2; 95% CI, 1.3-3.3).

Participants who were treated at centers assigned EHR plus education had a greater understanding of medication instructions and dosing compared with usual care for hypertension medications (OR = 2.3; 95% CI, 1.1-4.8) and all medications combined (OR = 1.7; 95% CI, 1-2.8).

Hypertension medication adherence did not improve in centers assigned EHR tools alone or with education compared with usual care (OR = 0.9; 95% CI, 0.6-1.4 for both). This was also seen for knowledge of chronic drug indications in centers assigned EHR tools alone (OR = 1; 95% CI, 0.6-1.5) or EHR plus education (OR = 1.1; 95% CI, 0.7-1.7) vs. the usual care.

“The finding of higher blood pressure among the group that received EHR tools alone was unexpected,” Persell and colleagues wrote. “We speculate that medication information sheets (which contain some information on adverse drug effects) may have led some patients to stop or reduce antihypertensive therapy. Medication review may have uncovered some cases where individuals were using duplicate medications.” – by Darlene Dobkowski

Disclosures: Persell reports he received unrelated research support from Omron Healthcare Co. and Pfizer. The other authors report no relevant financial disclosures.