New AHRQ Study Examines Health IT Tool Intended To Improve Medication Monitoring

An electronic tool to support laboratory monitoring between primary care office visits improved low-density lipoprotein (LDL) testing intervals for patients, but didn’t improve hemoglobin A1c or LDL control, according to an AHRQ-funded study. In a randomized controlled trial, researchers examined the clinical impact of a health information technology (IT) tool designed to improve between-visit ordering and tracking of laboratory testing for more than 3,500 primary care patients who were prescribed oral medications for hyperlipidemia, diabetes and/or hypertension over a 12-month period. The study and abstract, “Randomized Trial of a Health IT Tool to Support Between-Visit Based Laboratory Monitoring for Chronic Disease Medication Prescriptions,” appeared online January 6 in the Journal of General Internal Medicine. The study’s authors noted that, with the increasing prevalence of chronic conditions such as high cholesterol, type 2 diabetes and hypertension, innovations designed to improve medication management have the potential to significantly improve the nation’s health. However, they said, new payment models and workflow practices that integrate nonvisit clinical work might be needed before medication management systems used outside of office visits can be more widely adopted.

2015 May;30(5):619-25. doi: 10.1007/s11606-014-3152-y. Epub 2015 Jan 6.

Randomized Trial of a Health IT Tool to Support Between-Visit-Based Laboratory Monitoring for Chronic DiseaseMedication Prescriptions.

Grant RW1, Ashburner JM, Jernigan MC, Chang J, Borowsky LH, Chang Y, Atlas SJ.

Author information

Abstract

BACKGROUND:

Lack of timely medication intensification and inadequate medication safety monitoring are two prevalent and potentially modifiable barriers to effective and safe chronic care. Innovative applications of health information technology tools may help support chronic diseasemanagement.

OBJECTIVE:

To examine the clinical impact of a novel health IT tool designed to facilitate between-visit ordering and tracking of future laboratorytesting.

DESIGN AND PARTICIPANTS:

Clinical trial randomized at the provider level (n = 44 primary care physicians); patient-level outcomes among 3,655 primary care patients prescribed 5,454 oral medicines for hyperlipidemia, diabetes, and/or hypertension management over a 12-month period.

MAIN MEASURES:

Time from prescription to corresponding follow-up laboratory testing; proportion of follow-up time that patients achieved corresponding risk factor control (A1c, LDL); adverse event laboratory monitoring 4 weeks after medicine prescription.

KEY RESULTS:

Patients whose physicians were allocated to the intervention (n = 1,143) had earlier LDL laboratory assessment compared to similar patients (n = 703) of control physicians [adjusted hazard ratio (aHR): 1.15 (1.01-1.32), p = 0.04]. Among patients with elevated LDL (486 intervention, 324 control), there was decreased time to LDL goal in the intervention group [aHR 1.26 (0.99-1.62)]. However, overall there were no significant differences between study arms in time spent at LDL or HbA1c goal. Follow-up safety monitoring (e.g., creatinine, potassium, or transaminases) was relatively infrequent (ranging from 7 % to 29 % at 4 weeks) and not statistically different between arms. Intervention physicians indicated that lack of reimbursement for non-visit-based care was a barrier to use of the tool.

CONCLUSIONS:

A health IT tool to support between-visit laboratory monitoring improved the LDL testing interval but not LDL or HbA1c control, and it did not alter safety monitoring. Adoption of innovative tools to support physicians in non-visit-based chronic disease management may be limited by current visit-based financial and productivity incentives.