Using Information Technology for Patient-Centered Communication and Decisionmaking about Medications

Medication errors are a significant source of patient injury, hospitalization, and even death. The management of medication information requires a partnership between a patient and their caregivers in order to reconcile the medications a patient is thought to be taking with medications they are actually taking. This project looked at the integration of patient-centered interventions targeting patients, their providers, and their healthcare organization in an attempt to improve the medication management process. The focus was on using electronic medical record (EMR)-based tools to improve patients’ understanding of their prescribed medication regimens.

The interventions included the use of: 1) print materials; 2) standardized medication instructions that generate more patient-friendly and explicit prescription instructions; 3) EMR protocols and codes to upload materials and cue their generation either at the point of check-in to the clinic or at the time of a new order; and 4) a process for delivering the intervention that acknowledges common challenges in primary care.

The main objectives of the project were to:

• Develop and test a multimedia program (which was revised to an educational print piece) to help patients understand the importance of both giving and receiving accurate information about medications (pre-visit patient intervention).
• Use the EMR to encourage patient-centered medication management and extend the EMR medication management capability by training nurses to engage in a patient-centered review of current medications immediately before a patient sees the doctor. Leverage the EMR by developing a template that physicians can easily access to engage in a patient-centered discussion about new medications under consideration.
• Work with the practice-based research network to disseminate and track the use of effective interventions, and create pathways for facilitating national distribution to other practices.

The project evaluated the interventions via two randomized pre-post controlled evaluations. The first evaluation focused on EMR-based efforts to improve a patient’s understanding of new medications prescribed; the second study focused on EMR-based efforts to reconcile medication lists prior to a medical encounter to reduce discrepancies.

At the end of the funded project term, the first evaluation is still in progress. In the second evaluation, the project team found that they improved the ability to reduce discrepancies as related to omissions of prescriptions on the medication list. However, they had less success reducing discrepancies related to having medications on the medication list that are no longer being taken, and the lack of non-prescription medications on the list. Interviews with clinicians revealed barriers that were not addressed by the project’s intervention. These included an unwillingness to remove a medication ordered by another physician; a lack of perceived relevance of non-prescription medications; and a lack of time to enter complicated regimens into the EMR at the time of the visit.