title: Integration of Provider, Pharmacy, and Patient-Reported Data to Improve Medication Adherence for Type 2 Diabetes: A Controlled Before-After Pilot Study.
abstract: BACKGROUND
  Patients with diabetes often have poor adherence to using medications as prescribed. The reasons why, however, are not well understood. Furthermore, most health care delivery processes do not routinely assess medication adherence or the factors that contribute to poor adherence.
  
  
  OBJECTIVE
  The objective of the study was to assess the feasibility of an integrated informatics approach to aggregating and displaying clinically relevant data with the potential to identify issues that may interfere with appropriate medication utilization and facilitate patient-provider communication during clinical encounters about strategies to improve medication use.
  
  
  METHODS
  We developed a clinical dashboard within an electronic health record (EHR) system that uses data from three sources: the medical record, pharmacy claims, and a patient portal. Next, we implemented the dashboard into three community health centers. Health care providers (n=15) and patients with diabetes (n=96) were enrolled in a before-after pilot to test the system's impact on medication adherence and clinical outcomes. To measure adherence, we calculated the proportion of days covered using pharmacy claims. Demographic, laboratory, and visit data from the EHR were analyzed using pairwise t tests. Perceived barriers to adherence were self-reported by patients. Providers were surveyed about their use and perceptions of the clinical dashboard.
  
  
  RESULTS
  Adherence significantly and meaningfully improved (improvements ranged from 6%-20%) consistently across diabetes as well as cardiovascular drug classes. Clinical outcomes, including HbA1c, blood pressure, lipid control, and emergency department utilization remained unchanged. Only a quarter of patients (n=24) logged into the patient portal and completed psychosocial questionnaires about their barriers to taking medications.
  
  
  CONCLUSIONS
  Integrated approaches using advanced EHR, clinical decision support, and patient-controlled technologies show promise for improving appropriate medication use and supporting better management of chronic conditions. Future research and development is necessary to design, implement, and integrate the myriad of EHR and clinical decision support systems as well as patient-focused information systems into routine care and patient processes that together support health and well-being.
authors: Indiana University Richard M. Fairbanks School of Public Health, Department of Epidemiology, Indianapolis, IN, United States. bedixon@regenstrief.org.
authors: Brian E
authors: http://orcid.org/0000-0002-1121-0607
authors: BE
authors: Dixon
authors: Abdullah H
authors: http://orcid.org/0000-0003-2450-9656
authors: AH
authors: Alzeer
authors: Erin O'Kelly
authors: http://orcid.org/0000-0002-8951-2453
authors: EO
authors: Phillips
authors: David G
authors: http://orcid.org/0000-0003-2112-7812
authors: DG
authors: Marrero
keywords: barriers to medication use; computerized; diabetes mellitus; drug monitoring; health records; medical records systems; medication adherence; patient-centered care; personal; physician-patient relations; type 2