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21-12-2018 | Ophthalmology | News | Article

Electronic health record-linked glaucoma medication reminders well-received

medwireNews: The majority of patients with glaucoma appear willing to sign up to receive automated medication reminders linked to their electronic health records (EHR), with most describing them as useful, US research shows.

Michael Boland and colleagues from Johns Hopkins University School of Medicine in Baltimore, Maryland, say that although “dosing reminders for glaucoma medications have been shown to increase drug adherence”, they are currently limited by difficulties in linking the reminders to the patient’s current medication.

To address this, the researchers built a web-based reminder system that “allows patients to select a medication from their list in their EHR and then specify how (voice/text) and when they would like to be reminded” to use that drug.

They then approached 147 patients at a university-based glaucoma clinic in order to evaluate the system. Of these, 100 (68%) agreed to participate in the study.

Participants had been using glaucoma medication for 11.3 years on average and had a self-reported mean adherence rate of 91%. By comparison, nonparticipants had been using glaucoma medication for a shorter time (mean 8.9 years) and had a self-reported adherence rate of 97%.

Using a validated risk assessment score that considers age, race, general health, duration of medication use, self-reported adherence and whether or not a patient is following physicians’ orders, Boland and team categorised 9% of participants as being at high risk of poor adherence (≥50% probability of nonadherence) compared with 11% of nonparticipants.

Of the 100 patients who agreed to participate, 94 ultimately configured reminders, with most (81%) having help in doing so. Among the 17 participants who configured their own reminders, 14 (82%) said it was easy or very easy to do.

At 3 months, 74% of participants said the reminders were very useful or useful, 15% were neutral and 11% found them not useful.

Just under half (47%) said they were very likely or likely to continue using the reminders, 11% were neutral and the remaining 42% said they were very unlikely or unlikely to continue using them.

Of note, patients who said they would continue with the reminders were significantly more likely to be at high risk of poor adherence than those not wanting to continue (17 vs 2%).

Writing in JAMA Ophthalmology, Boland et al conclude: “Electronic health record–linked portals may represent a new and convenient way of allowing patients to link their glaucoma medications to automated reminders”.

They add that “additional longitudinal and glaucoma outcome data would help determine the clinical relevance of such portals.”

In an accompanying comment, Paula Anne Newman-Casey (University of Michigan, Ann Arbor, USA) and Jonathan Myers (Thomas Jefferson University, Philadelphia, Pennsylvania, USA) say that “electronic health record–based automated text and phone reminders may be an important, affordable, scalable strategy to begin to address one critical factor—poor medication adherence—that leads to vision loss in glaucoma.”

However, they point out that even though the current system was completely automated, most patients still needed help with implementation.

“Physicians are unlikely to be able to fulfill this role”, Newman-Casey and Myers remark.

They therefore call for “a more team-based approach to glaucoma care that involves ancillary staff alongside physicians to provide additional support for both patients with newly diagnosed glaucoma and patients having difficulties with medication and appointment adherence.”

By Laura Cowen

medwireNews ( is an independent medical news service provided by Springer Healthcare. © 2018 Springer Healthcare part of the Springer Nature group