JMIR Publications

ABSTRACT

Background:

Poor medication adherence is common, with approximately half of patients not taking their medications as prescribed. While non-adherence can negatively impact patient safety and health outcomes, few mechanisms exist in clinical practice to monitor how and if patients take medications in outpatient settings.

Objective:

To pilot-test the Electronic Medication Complete Communication (EMC2) strategy, a low-cost, sustainable approach that uses electronic health record (EHR) technology to promote outpatient medication adherence and safety.

Methods:

The EMC2 strategy was implemented in two academic practices for 14 higher-risk diabetes medications. The strategy included: 1) clinical decision support alerts to prompt provider counseling on medication risks; 2) low-literacy medication summaries for patients; 3) a portal-based questionnaire to monitor outpatient medication use; and 4) clinical outreach for identified concerns. We recruited adult patients with diabetes who were prescribed a study medication. Participants completed a baseline and two-week interview to assess receipt of, and satisfaction with, intervention components.

Results:

100 patients were enrolled; 90 completed the two-week interview. Patients were 56.2 years old on average. Most were female (57/100) and White (48/100) or African-American (37/100). About a quarter (28/100) did not have a portal account; socioeconomic disparities were noted in account ownership. Among patients with an account, 58% (42/72) completed the questionnaire; 21 of the 42 patients reported concerns warranting clinic follow-up. Of these, 17 were contacted by the clinic or had their issue resolved within 24 hours. Patients reported high levels of satisfaction.

Conclusions:

Findings suggests the EMC2 strategy can be reliably implemented and delivered to patients, with high levels of satisfaction. Disparities in portal use may restrict intervention reach. While the EMC2 strategy can be implemented with minimal impact on clinic workflow, future trials are needed to evaluate its effectiveness to promote adherence and safety. Clinical Trial: Not Applicable