The Medication Metronome Project

A major goal of primary care is to reduce the morbidity and mortality associated with chronic diseases such as hypertension, type 2 diabetes, and hyperlipidemia. However, national and local data indicate that the United States health care system is falling significantly short of evidence-based goals for these three conditions. Lack of timely medication intensification and inadequate safety monitoring among patients taking prescription medications have been identified as two prevalent and potentially modifiable barriers to effective and safe chronic care.

The Medication Metronome Project tested a medication management system that enables specific clinical actions, such as the decision to initiate or adjust medications, independent of the office visit. Additionally, the Medication Metronome system enables providers to schedule future laboratory tests related to a specific set of medications for glycemic, cholesterol, and blood pressure management. As these lab test dates become due, the Medication Metronome system reminds patients via letter and informs providers if a test is not performed.

The specific aims of this project were as follows:

• Develop the Medication Metronome system. 
• Conduct a randomized controlled trial of the Medication Metronome system. 
• Evaluate the impact of the Medication Metronome visit-independent care model on both the frequency and content of office-based visits. 

The Medication Metronome was evaluated with a randomized trial at the provider level. Patients whose physicians were allocated to the intervention had earlier low-density lipoprotein (LDL) laboratory assessment compared to patients of control physicians. Among patients with elevated baseline LDL, there was a slight decrease in time to achieving the LDL goal for the intervention group; however, the finding was not statistically significant. There were no significant differences between study arms in time spent at the LDL or Hemoglobin A1c goals. Medication safety monitoring was infrequently performed and not statistically different between study arms.

The project team concluded that systems like Medication Metronome, that support clinical care outside of the traditional in-person visit, will have greater adoption and clinical impact as primary health care evolves.