Electronic Medication Adherence Reporting and Feedback During Care Transitions (Massachusetts)

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Electronic Medication Adherence Reporting and Feedback During Care Transitions - Final Report

Citation:
Schnipper J. Electronic Medication Adherence Reporting and Feedback During Care Transitions - Final Report. (Prepared by Brigham and Women's Hospital under Grant No. R21 HS024587). Rockville, MD: Agency for Healthcare Research and Quality, 2019. (PDF, 655.68 KB)

The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. (Persons using assistive technology may not be able to fully access information in this report. For assistance, please contact Corey Mackison).
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A National Web Conference on the Role of Health IT to Improve Medication Management

Event Details

  • Date: September 13, 2018
  • Time: 1:00pm to 2:30pm
This AHRQ Web conference addressed the potential of health IT to improve medication monitoring, adherence, and medication therapy management for patients with complex conditions. Presenters discussed a text messaging system for patients with chronic conditions, the effects of a smart pillbox intervention on patient medication adherence after hospital discharge, and recommendations for clinical decision support used by community pharmacists delivering medication therapy management.
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The use of a “smart” pillbox, a pre-filled electronic medication tray that sends electronic alerts and reports to patients, caregivers, and primary care providers for patients discharged from the hospital, improves patients’ medication adherence post-hospitalization, leading to health improvements among patients, such as blood pressure control.

Project Details - Ended

Summary:

Patients often have issues with their medications once discharged from the hospital. Adverse drug events are common due to many factors, including misunderstanding of the prescribed medication regimen and nonadherence with that regimen. To address this, the Smart Pillbox Transition Study research team developed and implemented an electronic pillbox with prefilled weekly medication trays that can alert patients when it is time to take their medications, alert family members via text message or email if there is an issue, and produce a report of medication-taking habits for patients’ primary care providers.

The research team evaluated the effects of this smart pillbox intervention both on patients’ ability to take their medications safely and on the control of chronic conditions such as high blood pressure.

The specific aims of this research were as follows:

  • Implement a smart pillbox intervention for patients discharged from the hospital to the community. 
  • Evaluate the effects of the intervention on post-discharge medication discrepancies, medication adherence, and chronic disease management. 
  • Determine barriers and facilitators of implementation of the intervention. 

Two hundred and seven patients being discharged from a hospital and taking five or more chronic medications participated in a cluster-randomized control trial. Participants were randomized to receive the smart pillbox or a standard pillbox. Participants with the smart pillbox were contacted by a pharmacy technician on the day of discharge for information regarding their medication regimen to add into the pillbox software. Additionally, the patient received a demonstration on how to use the smart pillbox, an informational pamphlet, and an opportunity to ask questions regarding use of the smart pillbox. Patients assigned to the standard pillbox were given a weekly pillbox on the day of discharge with further instructions on how to fill it and how to properly use it.

Preparing the device and educating the patient on the smart pillbox use was found to require approximately 2 hours. Because the discharge process is already a complex process, the researchers found the addition of the smart pillbox to be time consuming and burdensome. Additionally, the smart pillbox medication manual data entry process was time consuming to the pharmacy technician, as the software in the smart pillbox was not compatible with the pharmacy’s electronic health record system and required double data entry for the patient medical regime. Despite the barriers, the smart pillbox intervention showed better medication adherence and health improvements among patients, such as blood pressure control. Future enhancements to technological design and implementation of the smart pillbox show promise to improve medication adherence post-hospitalization.