Medication Adherence Clinical Trial
Official title:
Impact of Information Prescriptions on Medication Adherence in ED Patients
The main objectives of this research are:
1. To identify factors that influence medication adherence rates in Emergency Department
(ED) patients.
2. To measure the effects of alternative information prescriptions on medication adherence
rates of ED patients.
3. To measure the effects of alternative information prescriptions (IRxs) on health and
service utilization.
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 strategy that may improve medication adherence among
ED patients is a better information exchange between the patient, provider and the health
care system. This study will use a randomized controlled trial to test the effect that two
alternative ways of delivering information prescriptions (IRxs) have on medication adherence
and treatment outcomes of ED patients.
ED patients treated and released with a prescribed medication(s) from three hospitals serving
different patient populations in the Baltimore metropolitan area over a 9 month period will
be included 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) practical assistance
which consists of giving information to help subject obtain medicine (i.e. programs that
offer drugs more cheaply, pharmacy hours of operation, etc)(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 practical assistance
and 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. Self-reported use of MedlinePlus will also be compared to electronic data for all
subjects. Self-reported medication and ED revisits/hospitalizations will be compared to
pharmacy claims and utilization data for subjects covered by Medicaid.
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