Effects of an online personal health record on medication accuracy and safety: a cluster-randomized trial

Abstract

Objective: To determine the effects of a personal health record (PHR)-linked medications module on medication accuracy and safety.

Design: From September 2005 to March 2007, we conducted an on-treatment sub-study within a cluster-randomized trial involving 11 primary care practices that used the same PHR. Intervention practices received access to a medications module prompting patients to review their documented medications and identify discrepancies, generating 'eJournals' that enabled rapid updating of medication lists during subsequent clinical visits.

Measurements: A sample of 267 patients who submitted medications eJournals was contacted by phone 3 weeks after an eligible visit and compared with a matched sample of 274 patients in control practices that received a different PHR-linked intervention. Two blinded physician adjudicators determined unexplained discrepancies between documented and patient-reported medication regimens. The primary outcome was proportion of medications per patient with unexplained discrepancies.

Results: Among 121,046 patients in eligible practices, 3979 participated in the main trial and 541 participated in the sub-study. The proportion of medications per patient with unexplained discrepancies was 42% in the intervention arm and 51% in the control arm (adjusted OR 0.71, 95% CI 0.54 to 0.94, p=0.01). The number of unexplained discrepancies per patient with potential for severe harm was 0.03 in the intervention arm and 0.08 in the control arm (adjusted RR 0.31, 95% CI 0.10 to 0.92, p=0.04).

Conclusions: When used, concordance between documented and patient-reported medication regimens and reduction in potentially harmful medication discrepancies can be improved with a PHR medication review tool linked to the provider's medical record.

Trial registration number: This study was registered at ClinicalTrials.gov (NCT00251875).

Conflict of interest statement

Competing interests: <?release-delay 12|0 >Drs Schnipper, Gandhi, and Poon are consultants to QuantiaMD, for whom they have created on-line educational materials for both providers and patients regarding patient safety, including medication safety. The findings of this study are not a part of those materials and the work with QuantiaMD in no way influenced the content of this manuscript. Dr Schnipper has received grant funding from Sanofi Aventis for an investigator-initiated study to design and evaluate an intensive discharge and follow-up intervention in patients with diabetes. The funder has no role in the design of the study, and the content is not relevant to the current manuscript. Dr Poon is a consultant to Becton, Dickinson, and Company, for whom he has presented at an internal educational forum. The findings of this study are not a part of those materials and the work with Becton, Dickinson, and Company in no way influenced the content of this manuscript. No other authors have any financial interests in the subject matter or materials discussed in the manuscript.

Figures

Figure 1

Study flow diagram. *‘No match’ indicates patients in the active control arm who did not match any patient in the intervention arm of the sub-study by practice and by date and type of visit. †‘Opted out’ includes those patients who opted out by email after receiving the invitation to participate in the medications sub-study and those who declined participation once contacted by phone. ‡‘Never called’ indicates those patients in the active control arm who did not need to be called because a sufficient number of eligible patients had already been enrolled. PCP, primary care provider.