JAMIA: PHR med review tool reduces discrepancies

Concordance between documented and patient-reported medication regimens and reduction in potentially harmful medication discrepancies can be improved with a PHR medication review tool linked to the provider's medical record, according to a Journal of the American Medical Informatics Association article published online May 3.

Medication-related morbidity and mortality is estimated to result in $76 billion in total costs annually, and adverse drug events are estimated to occur in one-quarter of ambulatory patients. Of these, 11 percent are considered preventable.

Jeffrey Schnipper, MD, MPH, division of general medicine, Brigham and Women's Hospital in Boston, and colleagues conducted an on-treatment substudy within a cluster-randomized trial involving 11 primary care practices that used the same PHR. Over an 18-month period, intervention practices received access to a medications module prompting patients to review their documented medications and identify discrepancies, generating ‘eJournals’ that enabled rapid updating of medication lists during subsequent clinical visits.

A sample of 267 patients who submitted medications eJournals was contacted by phone three weeks after an eligible visit and compared with a matched sample of 274 patients in control practices that received a different PHR-linked intervention. Two blinded physician adjudicators determined unexplained discrepancies between documented and patient-reported medication regimens. The primary outcome was proportion of medications per patient with unexplained discrepancies.

Among 121,046 patients in eligible practices, 3,979 participated in the main trial and 541 participated in the sub-study. The proportion of medications per patient with unexplained discrepancies was 42 percent in the intervention arm and 51 percent in the control arm. The number of unexplained discrepancies per patient with potential for severe harm was 0.03 in the intervention arm and 0.08 in the control arm. This difference was mainly driven by fewer additional medications (57 percent vs. 68 percent of patients) and less so by fewer missing medications (29 percent vs. 36 percent of patients).

The researchers believe that the medications module used “encouraged patients to review their medication regimen as displayed in the ambulatory EHR and note discrepancies, and it activated PCPs to update the medication list. The results of the survey suggest that it may also have led to discussions about medication adherence and potential side effects.”

The authors noted several limitations of the study. Only a small proportion of patients theoretically eligible to participate were evaluated, the low enrollment rate of the hospital’s PHR limits the generalizability of the findings, the study was conducted in one medical system using internally developed software and the sample size of the medications substudy was small and had limited power to detect clinically important differences in some secondary outcomes.

“Future work is needed to increase patient enrollment in PHRs and to close the well-documented ‘digital divide’ between users and non-users of HIT,” the authors wrote. “This technology shows promise, and further studies should be conducted integrating this kind of tool into other EHR platforms and evaluating its effects on medication safety.”