title: EHR-based medication support and nurse-led medication therapy management: rationale and design for a three-arm clinic randomized trial.
abstract: BACKGROUND
  Patients with chronic conditions often use complex medical regimens. A nurse-led strategy to support medication therapy management incorporated into primary care teams may lead to improved use of medications for disease control. Electronic health record (EHR) tools may offer a lower-cost, less intensive approach to improving medication management.
  
  
  RESULTS
  The Northwestern and Access Community Health Network Medication Education Study is a health center-level cluster-randomized trial being conducted within a network of federally qualified community health centers. Health centers have been enrolled in groups of 3 and randomized to (1) usual care, (2) EHR-based medication management tools alone, or (3) EHR tools plus nurse-led medication therapy management. Patients with uncontrolled hypertension who are prescribed ≥ 3 medications of any kind are recruited from the centers. EHR tools include a printed medication list to prompt review at each visit and automated plain-language medication information within the after-visit summary to encourage proper medication use. In the nurse-led intervention, patients receive one-on-one counseling about their medication regimens to clarify medication discrepancies and identify drug-related concerns, safety issues, and nonadherence. Nurses also provide follow-up telephone calls following new prescriptions and periodically to perform medication review. The primary study outcome is systolic blood pressure after 1 year. Secondary outcomes include measures of understanding of dosing instructions, discrepancies between patient-reported medications and the medical record, adherence, and intervention costs.
  
  
  CONCLUSIONS
  The Northwestern and Access Community Health Network Medication Education Study will assess the effects of 2 approaches to support outpatient medication management among patients with uncontrolled hypertension in federally qualified health center settings.
authors.affiliation: Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL.
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Persell
authors.forename: Milton
authors.initials: M
authors.lastname: Eder
authors.forename: Elisha
authors.initials: E
authors.lastname: Friesema
authors.forename: Corinne
authors.initials: C
authors.lastname: Connor
authors.forename: Alfred
authors.initials: A
authors.lastname: Rademaker
authors.forename: Dustin D
authors.initials: DD
authors.lastname: French
authors.forename: Jennifer
authors.initials: J
authors.lastname: King
authors.forename: Michael S
authors.initials: MS
authors.lastname: Wolf
mesh_terms: D000554:Ambulatory Care Facilities; D057286:Electronic Health Records; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D054539:Medication Therapy Management; D009736:Nursing Process
keywords: adherence; electronic health records; hypertension; medication reconciliation; medication therapy management; nurse educator