EHR‐Based Medication Support and Nurse‐Led Medication Therapy Management: Rationale and Design for a Three‐Arm Clinic Randomized Trial

Abstract

BackgroundPatients 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.Methods and ResultsThe 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.ConclusionsThe 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.Clinical Trial RegistrationURL: clinicaltrials.gov. Unique identifier: NCT01578577.