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Editors Selection IGR 21-1

Medical Treatment: Patient Reminders to Increase Treatment Adherence

Comment by Sally Baxter on:

79746 Association of an Electronic Health Record-Linked Glaucoma Medical Reminder With Patient Satisfaction, Varadaraj V; Friedman DS; Boland MV, JAMA ophthalmology, 2019; 137: 240-245

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Glaucoma medication adherence remains an ongoing challenge. Here, the authors used the electronic health record (EHR) patient portal to send patients dosing reminders for glaucoma medications. Participants underwent a baseline assessment of their risk of non-adherence (from 0% to 100% using a validated instrument), with high risk defined as ≥ 50%. When configuring reminders, they selected the medication(s), mode of reminder delivery (i.e., voice call vs. text), and the timing of reminders. Patient satisfaction with the system and likelihood of ongoing use were measured three months later.

Of 147 patients approached, 100 participated. Most (64%) were men; more than half (51%) were white. Self-reported adherence exceeded 90% in both participants and non-participants. Only nine (9%) participants were high risk for nonadherence. Most (74%) participants found the reminders to be useful, while 15% were neutral, and 11% found them not useful. About half (47%) of the patients reported they were very likely or likely to continue using these reminders, while 11% were neutral and another 42% said they were unlikely to continue use.

47% of the patients reported they were very likely or likely to continue using these reminders

Overall, this EHR-linked automated reminder system was well-received in the study. However, several issues require further consideration. Firstly, there was no objective measure of whether the patients dispensed the medication when reminded. Possible strategies to address this include sensors embedded in medication packaging and video recognition technology to verify patient consumption. Secondly, the participants were majority white males with high baseline adherence. EHR-linked reminders should also be studied in patients with high risk of non-adherence with greater representation of women and minorities, who carry a disproportionate burden of glaucoma blindness. Thirdly, more extended follow-up would enable observation of the long-term effects on patient behavior. Patients may also develop the 'alert fatigue' that has limited efficacy of many EHR-based clinical decision support tools designed to influence physician behavior.¹ Finally, while EHRs have become widespread, use of EHR-based patient portals is still not as high as expected.² This study is an excellent starting point and highlights the need for ongoing work to develop methods for facilitating patient engagement, particularly for high-risk patients, to address this important problem of glaucoma medication adherence.

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