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EHR-linked glaucoma medication reminder may improve adherence


Findings from a prospective study conducted at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, demonstrate the feasibility of creating an automated reminder system for glaucoma medications using the electronic health record (EHR) and show that such a system is generally well-received by patients.

Investigators noted that additional longitudinal studies are needed to determine the clinical relevance of the portal-linked system for improving medication adherence and glaucoma outcomes.

Reported in the March 2019 issue of JAMA Ophthalmology [Varadaraj V, et al. Association of an electronic health record-linked glaucoma medical reminder with patient satisfaction. JAMA Ophthalmol. 2019;137:240-245], the study recruited patients from the Wilmer Eye Institute glaucoma clinic who were being treated with IOP-lowering medications.

Patients were approached from April 2017 to January 2018 and asked about their willingness to use a computer-based system to configure medication reminders.

Those who agreed to enter the study were interviewed to assess medication adherence, current use of reminders, and the likelihood they would use EHR-linked reminders. Participants were asked to set up the reminders themselves or with the assistance of a family member, but help from a research coordinator was available if preferred.

The reminders were voice- or text-based. Text-based messages also asked patients to respond within 30 minutes, and if patients failed to respond, the system delivered a second message encouraging them to respond.

Three months after entering the study, participants were contacted by telephone and interviewed again for feedback about their experience with the system.

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The recruitment effort showed reasonable patient willingness to use such a system. Of 147 patients approached about entering the study, 100 (68%) agreed to participate. The 100 participants had a mean age of 65 years, included 54 men and 46 women, represented a heterogeneous racial mix (51% whites, 33% blacks, and 13% Asians), and had been on glaucoma medications for an average of 11.3 years.

Compared with patients who declined to participate, those who were willing were similar with respect to most baseline characteristics.

Interestingly, patients who participated had a lower self-reported medication adherence rate than those who were unwilling (91% versus 97%).

However, rating of risk for poor adherence (defined as ≥50% probability of nonadherence) using a previously validated scoring system showed that the percentage of patients rated at high risk for poor adherence was slightly lower within the group that agreed to participate than in the group that declined (9% versus 11%).

Overall, 94 of the 100 patients who agreed to participate configured the reminders; 72 patients requested help with the configuration, but those who set it up themselves found it was easy to use.

The majority of patients chose to receive text messages (67%), and about one-fourth preferred voice message reminders, while the remainder wanted email notification. The majority of patients (69%) were using more than one topical medication, but two-thirds of patients chose to configure a reminder for just one medication rather than for all of the drops they were using.

Of the 94 patients who configured the reminders, 89 (95%) completed the 3-month follow-up visit. Data from the follow-up interviews showed that about three-fourths of the patients found the reminders to be useful, while 15% were neutral about their value, and 11% said they were not useful.

However, only 47% of patients said that they were very likely or likely to continue using the reminders, while 11% were neutral, and 42% said they were unlikely or very unlikely to continue.

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Research rationale

Nonadherence with glaucoma medications is a well-recognized problem. Previous research has established that forgetting to use medications is a leading cause for poor adherence and that automated telecommunication-based reminders can improve adherence.

Varadaraj and colleagues noted that broad adoption of automated reminders has been hampered by the difficulty linking them to the medications patients are using. They believed that the EHR offered an opportunity to address this issue and would have the advantage of allowing clinician oversight to ensure application to currently used medications.

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