Physicians and nurses enter medications in visit notes, often with the help of EMR-integrated medical transcription services. However, getting patients to adhere to their medication prescriptions is a major concern for healthcare providers. Studies show that poor medication adherence causes preventable deaths and costs the U.S. economybillions of dollars annually. The good news is that a new study found that online access to visit notes can promote medication adherence. Published by leaders from OpenNotes, the study covered 20,000 patients at three early OpenNotes facilities – Beth Israel Deaconess Medical Center (BIDMC), the University of Washington Medicine (UW), and Geisinger Health System.
Medication adherence is necessary to properly manage symptoms, reduce adverse reactions, and improve quality of life. Nonadherence can lead to adverse outcomes especially in patients who have various comorbilities and take multiple medications. It can increase risk of ED visits, and hospitalizations, and death.
A research review published in Annals of Internal Medicine estimated poor medication adherence costs the U.S. health care system between $100 billion and $289 billion annually. Lack of adherence was responsible for approximately 125,000 deaths each year, as well as at least 10 percent of hospitalizations that occur every year.According to the review, studies consistently show that “20 percent to 30 percent of medication prescriptions are never filled, and that about 50 percent of medications for chronic disease are not taken as prescribed.” The researchers found that individuals who take prescription drugs generally only take about 50 percent of the prescribed doses.
Experts say a lack of medication adherence also can explain why some prescription drugs appear to work better in studies than they do among the general population, and why patients experience relapses or die when they have been prescribed medication that should control their conditions, New York Times’ “Well” reports. Simply put, former Surgeon General Everett Koop said, “Drugs don’t work in patients who don’t take them.”
Experts suggest that medication adherence can be improved via mobile medication management, pharmacist interventions, predictive analysis and integrated data systems, and lowering the costs of drugs.
Patient compliance refers to the extent to which a patient correctly follows medical advice. The new OpenNotes survey suggests that patients who read their visit notes are more likely to understand prescription advice and follow it. Summarizing the findings the study, Patient Engagement HIT reports that access to clinician notes helped
- 64 percent of patient respondents better understand why their clinician prescribed a certain medication,
- Another 62 percent feel more in control of their medications
- 57 percent of respondents find answers to questions they had about their medications, saving them a call to their doctors
- 61 percent of respondents feel more comfortable taking their medications
While 14 percent of patients at BIDMC and Geisinger reported that access to visit notesimproved their ability to adhere to medication plans, at UW, thirty-three percent of patients reported medication adherence improvements. Patients who did not speak English or who have lower literacy scores were found to have more noticeable improvements.
Catherine DesRoches, DrPH, executive director of OpenNotes describes sharing clinical notes with patients as a “relatively low-cost, low-touch intervention.” (patientengagementhit.com).
However, the study’s co-author recognizes that this kind of transparent communication is not easy as it is a departure from convention. Physicians considering note-sharing for the first time would tend to worry aboutpotential effects on their workflow and about making their patients nervous. But he points out that experience shows that patients approve it and it holds great promise for medication adherence. In addition, transparency is mandated by federal law and policy and providers need to utilize the opportunity to share health care information to promote clinical management and health improvement.
Giving patients the ability to access their notes can boost medication adherence. For this to work, physicians need to maintain accurate medication records, and according to Mag Mutual, this can be a challenge. Medication reconciliation, the process recommended for providers to maintain the most complete and accurate list possible of a patient’s current medications, can be compromised by several factors such aspatients’ lack of knowledge of their medications,physician and nurse workflows, frequent changes in patients’ medications, use of undocumented over-the-counter medicines,and lack of integration of patient health records across the continuum of care.
A collaborative approach to medication management requires both patient and provider interventions. Among other things, accurate and timely charting is crucial. Outsourcing medical transcription can help with this by allowing physicians maintain precise, concise and clear visit notes with a medication list that includes continued medications, modified medications, new medications and discontinued medications.
