From the 2018 HVPAA National Conference
Varshini Varadaraj (Wilmer Eye Institute @ Johns Hopkins Hospital), David Friedman (Wilmer Eye Institute @ Johns Hopkins Hospital), Michael Boland (Wilmer Eye Institute @ Johns Hopkins Hospital)
Background
Patient non-adherence with glaucoma medications is a common problem. While automated dosing reminders for glaucoma medications have been shown to increase drug-adherence, an outstanding limitation preventing broad adoption of this approach is the difficulty linking reminders to the particular medication(s) in each patient’s electronic health record (EHR).
Objectives
To examine the feasibility of implementing an EHR-linked, telecommunication-based, automated reminder system for glaucoma medications, and to assess patient satisfaction with it.
Methods
This prospective, cross-sectional study was conducted in a university-based glaucoma clinic and included patients already on glaucoma medications. We added a web-based application to our EHR patient portal that allows patients to establish telecommunication-based reminders for their glaucoma medications. For all potential subjects, basic non-identifiable information was collected to determine the risk of non-adherence with glaucoma medications. Those who consented to participate then answered questions related to medication adherence, reminders, and their likelihood of using EHR-linked reminders. They then configured reminders using the EHR patient portal. After 3 months, they answered questions about their satisfaction with the system.
Results
Of 147 patients approached, 68% (N=100) agreed to participate in the study. There were no differences between those willing and unwilling to participate (p>0.05), except for a slightly lower self-reported medication adherence rate among those who participated (91 vs. 97%), p=0.009. Based on a previously validated risk assessment score, 9% (9/100) of participants were categorized as high-risk (≥50% probability of non-adherence) as compared to 11% (5/47) of non-participants, p>0.05. Of the 100 participants, 94 ultimately configured reminders, of whom 88 (94%) completed 3-month follow-up. On follow-up, 75% of participants found the reminders to be “very useful” or “useful”, 15% were “neutral”, and 10% found them “not useful” or “not at all useful”. Most participants (81%) had help configuring reminders in clinic, while 19% participants configured them on their own. Of the 17 participants that self-configured reminders, 14 found it was “very easy” or “easy”, while 3 found it was “very difficult” or “difficult”.
Conclusion
EHR-linked, automated, telecommunication-based reminders had good uptake, and were received well among patients at a tertiary glaucoma clinic.
Implications for the Patient
Given the increasing ubiquity of electronic collection and storage of patient health information, an EHR-linked reminder system for glaucoma medications may represent a new and convenient method of allowing patients to link their glaucoma medications to automated reminders.
