The Use of Electronic Personal Health Records to Improve Medication Adherence and Patient Engagement: A Randomized Study of Non-valvular Atrial Fibrillation Patients

Abstract

ABSTRACT. Embolic stroke is a major complication of atrial fibrillation (AF) that frequently results in disability or death. The administration of oral anticoagulation can reduce stroke risk in AF patients; however, medication non-adherence can eliminate this benefit. To date, reported patient adherence rates to oral anticoagulation regimens vary. The objective of the current study was to examine the impact of medication-specific education delivered via a personal health record (PHR) system on medication adherence. A randomized, prospective study was conducted from February 2014 to June 2014 at Parkview Health, a not-for-profit, community-based health care clinic that serves a northeastern Indiana population of more than 820,000. AF patients receiving dabigatran (Pradaxa s ; Boehringer Ingelheim GmbH, Ingelheim am Rhein, Germany) to prevent stroke participated in this study. The study participants were predominantly Caucasian males over 65 years of age who were educated, insured, and living above the poverty level. Patients were allowed to view online, download, and transmit health information via a PHR. The intervention group received PHR training and dabigatran education via the PHR. The control group received standard care and PHR access without training. A longitudinal survey pertaining to medication knowledge, medication adherence, and patient engagement was administered at baseline and at the end of the study. Medication-dispensing data collected from pharmacy refill prescriptions were used for calculating the medication possession ratio (MPR). Ninety patients were included in this study, and were randomly assigned to either the intervention group (n ¼ 46) or the control group (n ¼ 44). All participants completed the baseline survey, and 95.6% of patients finished the follow-up survey. The mean score for knowledge increased significantly in the intervention group (from 3.77 to 4.23, p ¼ 0.005), but not in the control group (from 3.70 to 3.95, p ¼ 0.72). The MPR was significantly higher in the intervention group (97.47% vs. 87.67%, p ¼ 0.001). Both groups had similar levels of improvement in Patient Activation Measure scores (from 63.0 to 65.8, p ¼ 0.078 vs. from 63.1 to 63.6, p ¼ 0.814). Patients who used the PHR achieved greater medication knowledge, resulting in improved medication adherence. To our knowledge, no published randomized trial has reported on the use of PHRs to improve medication adherence and knowledge. This study is the first to demonstrate a positive impact on anticoagulation adherence with PHR use.

Can nurses help improve self‐care of patients living with atrial fibrillation? A focus group study exploring patients' disease knowledge gaps

“…This re‐education approach is not new; a previous study demonstrated that a complex education intervention increased AF patients' knowledge of their condition at both 12 and 24 months (Taitel, Mu, Gooptu, & Lou, 2017). In our own pilot work, we found that both AF knowledge and OAC adherence could be increased by the use of tailored digital education through the electronic health record (Chen et al, 2017). Though participants in this study suggested tailoring precise timing to the individual for maximum effectiveness, many agreed it would be helpful to initially receive more frequent follow‐ups for a short period of time immediately after diagnosis (i.e.…”

“…They generally rated their computer literacy as adequate, but the age group most affected by AF (65+) contains a wide range of technological capabilities. However, prior research has demonstrated effectiveness in using a computerized PHR to deliver messaging to AF patients that increases knowledge and adherence (Chen et al, 2017), as well as that, although older patients rate their computer literacy lower, they may be more likely to actively use electronic methods of monitoring their health once they are introduced and trained on how to use them (Toscos et al, 2016). Our participants' current device use (i.e.…”

“…Beyond verbal instruction or scheduled refill reminders, there is potential for technology interventions to give a means for education outside of office visits. For example, our prior work illustrated the potential of personalized education for AF patients on OAC knowledge and self‐reported adherence among those who received tailored education via personal health records (PHRs; Chen, Roebuck, Sami, Erison, & Mirro, 2017). One of the advantages of electronic messaging is that it can be automated or personalized, allowing for “quick” education and clinic responses without the necessity of an office visit or scheduled phone call.…”

A systematic review and meta-analysis of supplemental education in patients treated with oral anticoagulation

“…Independent screening and review of titles and abstracts for inclusion eligibility were conducted by 2 reviewers. Authors were contacted to obtain information on studies, including 2 with only abstract proceedings available at the time of search 15,19 and another for which additional information on mean knowledge and TTR values was required. 20 Because this review was an update of the review conducted by Wong et al, 9 references before 2012 were excluded from the screening process.…”

“…23 Authors were contacted to obtain data identified from abstract screening; however, the data were not published at the time of the analysis. 19 Two authors were contacted to provide means and SDs for knowledge scores, and data were obtained for 1 study 15 but not the other. 20 Heterogeneity of the eligible studies was assessed using the x 2 test, with significance at P , .10, and the I 2 statistic, 11 which was the primary measure used to assess degree of heterogeneity.…”