This application addresses broad Challenge Area (05 ) Comparative Effectiveness Research and the specific challenge topic is 05-LM-101: Effect of """"""""Information Prescriptions"""""""" on Improving Care by Increasing Compliance with Medication Protocol Given to Discharged Emergency Department Patients. People who are prescribed self-administered medications frequently take less than half the doses. Poor adherence to medication regimens is associated with worsening of disease, death and increased health care costs in the United States. The few studies conducted in the emergency department (ED) setting suggest that between 7 to 45 percent of patients do not fill their prescription;one study conducted in Canada reported that 45% of ED patients did not follow their prescribed regimen. One promising strategy to improve medication adherence among ED patients is a better information exchange between the patient, provider and the health care system. This application will use a randomized controlled trial to test the effect that three alternative ways of delivering information prescriptions (IRxs) have on medication adherence and treatment outcomes of ED patients. An information prescription (IRx) is a prescription of focused, evidence-based information to a patient at the right time to manage a health problem. Over a 9 month period, 4,500 ED patients treated and released with a prescribed medication(s) from three hospitals serving different patient populations in the Baltimore metropolitan area will be enrolled in the study. Research assistants will consent eligible patients, interview them prior to ED discharge and randomize subjects to one of four study groups: (1) usual care (medication prescription and instructions provided at discharge);(2) an IRx that consists of a referral to MedlinePlus;(3) an IRx that includes a MedlinePlus referral plus written information from MedlinePlus customized to the subject's health problem and prescribed medication;or (4) an IRx that consists of MedlinePlus referral plus customized written information from MedlinePlus plus access to information services provided by a medical librarian, herein referred to as a clinical informationist or informationist. Subjects will be contacted by telephone one week post ED visit and queried about medication use and patient outcomes (self-reported health, satisfaction with ED visit, and ED revisits or hospitalizations) and use of Internet to access health information. Medication instructions and ED discharge diagnosis data will be extracted from subjects'electronic medical record and use of informationist services documented. Medication adherence rates and patient outcomes will be compared among study groups. The proposed interventions are structured from low cost- intensity (IRx1) to higher cost-intensity (IRx3). It is expected that there should be increasing benefit with more intensive interventions. In addition, this study will compare self-reported use of MedlinePlus to electronic data for all subjects. Self-reported medication and ED revisits/hospitalizations will also be compared to pharmacy claims and utilization data for subjects covered by Medicaid. If IRxs enhance medication adherence, they should generalize to other settings, to chronic conditions (may be a greater impact) and to other types of treatments. Because the results may be applicable to any self-administered treatment, effective ways to help people follow medical treatments could have an enormous impact on patients'health and well-being. Many people do not take their medications as instructed and this can result in poorer health. This study will evaluate whether giving people more information about their health and prescribed drug through an information prescription results in an improvement in medication adherence and health.
Many people do not take their medications as instructed and this can result in poorer health. This study will evaluate whether giving people more information about their health and prescribed drug through an information prescription results in an improvement in medication adherence and health.
| Ding, Ru; Zeger, Scott L; Steinwachs, Donald M et al. (2013) The validity of self-reported primary adherence among Medicaid patients discharged from the emergency department with a prescription medication. Ann Emerg Med 62:225-34 |
| McCarthy, Melissa L; Ding, Ru; Roderer, Nancy K et al. (2013) Does providing prescription information or services improve medication adherence among patients discharged from the emergency department? A randomized controlled trial. Ann Emerg Med 62:212-23.e1 |
