Stephen D. Persell|Kunal N. Karmali|Danielle Lazar|Elisha M. Friesema|Ji Young Lee|Alfred Rademaker|Darren Kaiser|Milton Eder|Dustin D. French|Tiffany Brown|Michael S. Wolf
Effect of Electronic Health Record–Based Medication Support and Nurse-Led Medication Therapy Management on Hypertension and Medication Self-management
Northwestern University|Northwestern University|Access Community Health Network|Center for Discovery|Northwestern University|University of Minnesota|Northwestern University|Northwestern University|Northwestern Medicine|Access Community Health Network|Center for Discovery|University of Minnesota|Northwestern University|Northwestern University|Northwestern University
h3importanceh3 complex medication regimens pose selfmanagement challenges particularly among populations low levels health literacy h3objectiveh3 test medication management tools delivered commercial electronic health record ehr without nurseled education intervention h3design setting participantsh3 3group cluster randomized clinical trial performed community health centers chicago illinois participants included 794 patients hypertension selfreported using 3 medications concurrently purpose data collected april 30 2012 february 29 2016 analyzed intention treat h3interventionsh3 clinics randomly assigned groups electronic health recordbased medication management tools medication review sheets visit checkin lay medication information sheets printed visits ehralone group ehrbased tools plus nurseled medication management support ehr plus education group usual care h3main outcomes measuresh3 outcomes 12 months included systolic blood pressure primary outcome medication reconciliation knowledge drug indications understanding medication instructions dosing selfreported medication adherence medication outcomes assessed hypertension prescriptions prescriptions treat chronic disease medications h3resultsh3 among 794 participants 686 women mean sd age 527 96 years systolic blood pressure 12 months greater ehralone group compared usual care group 36 mm hg 95 ci 03 69 mm hg systolic blood pressure ehr plus education group significantly lower compared usual care group difference 20 mm hg 95 ci 52 13 mm hg lower compared ehralone group 56 mm hg 95 ci 88 24 mm hg 12 months hypertension medication reconciliation improved ehralone group adjusted odds ratio 18 95 ci 11 29 ehr plus education group adjusted odds ratio 20 95 ci 13 33 compared usual care understanding medication instructions dosing greater ehr plus education group usual care group hypertension medications 23 95 ci 11 48 medications combined 17 95 ci 10 28 compared usual care ehr tools alone ehr plus education interventions improve hypertension medication adherence 09 95 ci 0614 knowledge chronic drug indications ehr tools alone 10 95 ci 06 15 ehr plus education 11 95 ci 0717 h3conclusions relevanceh3 study found ehr tools isolation improved medication reconciliation worsened blood pressure combining tools nurseled support suggested improved understanding medication instructions dosing lower blood pressure compared usual care h3trial registrationh3 clinicaltrialsgov identifiernct01578577