Dive Brief:
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A new JAMA report found that EHRs with nurse-led support can improve patients following medication instructions.
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The three-group cluster randomized clinical trial in community health centers in Chicago involved nearly 800 hypertension patients, who were using at least three medications between April 30, 2012 and Feb. 29, 2016.
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The study showed the potential of nurse educators in reducing medication errors and improving self-management. However, the interventions didn’t have much of an effect on blood pressure levels.
Dive Insight:
Medication regimens can be confusing and result in self-management challenges for patients, especially those with low health literacy.
The three-group cluster randomized clinical trial in community health centers in Chicago involved nearly 800 hypertension patients, who were using at least three medications between April 30, 2012 and Feb. 29, 2016.
The study split patients into three groups: EHR-based medication management tools, EHR-based tools plus nurse-led medication management support and usual care.
The researchers found that hypertension medication reconciliation improved in both the EHR-alone group and the EHR plus education group compared to usual care at 12 months.
Understanding medication instructions and dosing were better in the EHR plus education group than the usual care group for hypertension medications and all medications combined. However, the EHR tools alone and EHR plus education interventions did not improve hypertension medication adherence or knowledge of chronic drug indications compared to usual care.
Blood pressure effects differed by group. The study found systolic blood pressure increased in the EHR-alone group at 12 months compared to the usual care group. Meanwhile, systolic blood pressure in the EHR plus education group was lower than the EHR-alone group, but not significantly lower than the usual care group.
These results show that giving patients EHRs without help isn't enough. Even then, pairing EHRs with nurse-led help falls short of showing a marked blood pressure improvement over usual care.
The study cited the potential of nurse-led interventions coupled with EHRs, though more work is needed.
“Even with the combined intervention, self-administration errors, medication discrepancies and incomplete adherence were common, leaving much room for improvement,” according to the study.
The JAMA report isn’t the first to show the importance of nurse-led support for medication compliance. A 2013 study on non-adherence to chronic medication said nurses are an “underutilized force in improving adherence and outcomes.”
“Counseling appears to be an effective approach that nurses can use to supplement other methods, building a multifaceted strategy to enhance adherence. Tackling non-adherence seems to demand continuous efforts and follow-up,” according to the European Journal of Clinical Pharmacology study.
A 2015 Family Practice study that evaluated the effect of nurse-led adherence support for people with uncontrolled high blood pressure found that adherence to blood pressure medication was better than previously reported. However, the nurse-led adherence program didn’t improve medication adherence or blood pressure compared to usual care. Plus, nurse-led adherence support was much more expensive, the Family Practice study said.