Improving Medication Adherence in Type 2 Diabetes With Integrated Approaches

Integrated approaches using electronic health records (EHRs), clinical decision support, and patient-controlled technologies may help improve the appropriate use of medication as well as the management of type 2 diabetes, according to the results of a recent 9-month pilot study published in JMIR Medical Informatics.

Researchers from Indiana University, the Regenstrief Institute, and the Department of Veterans Affairs in Indiana led by Brian E. Dixon, MPA, PhD, set out to see if a clinical “dashboard” the team developed within an EHR system could be implemented in 3 Indiana community health centers. The dashboard used data from the medical record, pharmacy claims, and a patient portal. Healthcare providers (n = 15) and patients with diabetes (n = 96) were enrolled in a before-and-after pilot to test the system’s effect on medication adherence and clinical outcomes.

Three types of EHR data relevant to diabetic patient populations were displayed on the dashboard: blood pressure, glycated hemoglobin, and cholesterol level. Each time a clinician selected a patient in the EHR, the dashboard refreshed with content from multiple sources: recent physiological data from the EHR, pharmacy data providing objective medication adherence data from a medication module, and patient-reported barriers to medication adherence. According to the researchers, the system created technical interfaces among EHR, Clinical Decision Support (CDS), and patient information systems that are integrated into clinical and personal ecosystems to create environments in which shared decision-making can be informed by evidence, individual health data, and knowledge of social determinants.

After the intervention was introduced, patients’ medication adherence improved significantly for every drug class in which mean adherence was below 80% prior to the intervention. Mean Proportion of Days Covered was observed to be above 80% at the end of the study.

“This may be the result of patients being exposed to the barriers questionnaire,” the authors hypothesized, “an exposure that may have stimulated their consideration of the importance of using medications as prescribed.”

Providers’ perceptions of the system were mixed. Thus, although the intervention shows potential for addressing patterns of medication use, it will require further work, especially with respect to more actively engaging providers and patients in using its data. No significant changes to clinical outcomes or healthcare utilization were observed.

The results from this pilot study are promising, but additional research and development is needed to improve design and integrate the myriad EHR and CDS systems and patient devices into routine care and patient processes that together will support health and well-being.