Current issues of ACP Journal Club are published in Annals of Internal Medicine


Quality Improvement

Computer-generated reminder charts increased patient knowledge of and drug compliance with prescribed drug regimens

ACP J Club. 1993 Sept-Oct;119:60. doi:10.7326/ACPJC-1993-119-2-060


Source Citation

Raynor DK, Booth TG, Blenkinsopp A. Effects of computer generated reminder charts on patients' compliance with drug regimens. BMJ. 1993 May 1;306:1158-61.


Abstract

Objective

To evaluate the effectiveness of a computer-generated reminder chart in improving patient drug compliance after hospital discharge.

Design

Randomized controlled trial with 10-day follow-up.

Setting

3 general medical wards of a district general hospital in the United Kingdom.

Patients

210 patients discharged from the hospital who were taking between 2 and 6 medicines on a regular basis. Exclusion criteria were hospital discharge to a nursing home or other institution, dependency on another person for administering medication, illiteracy, severe reading difficulty, or visual handicap. 197 patients (mean age 69 y, 110 men) completed the study.

Intervention

Patients were allocated to 1 of 4 groups. 2 groups received the individualized computer-generated reminder chart, 1 with additional routine counseling from a nurse (n = 50) and the other with additional structured counseling from a pharmacist with an explanation of the chart reminder (n = 48). The other 2 groups received counseling only, either from a nurse (n = 49) or from a pharmacist (n = 50).

Main outcome measures

Patient compliance with, and knowledge of, their drug regimen. Drug compliance was assessed by tablet counting at home visits a mean of 10 days after hospital discharge. Patients were also questioned about details of their drug regimen.

Main results

83% of patients who received the reminder chart correctly described their dose regimen compared with 47% of patients without the reminder chart (absolute difference 36% {95% CI 23% to 48%}*, P < 0.001). Patients not given a reminder chart had a mean compliance score of 86%. Patients given a reminder chart and counseled by a nurse had a compliance score of 91%, and patients given a reminder chart and counseled by a pharmacist had a compliance score of 95%. Analysis of variance showed that patients who received a reminder chart had a greater compliance score than those without a reminder chart (P < 0.001). A mean compliance score of > 85% was achieved by 86% of patients with a reminder chart compared with 63% without a reminder chart (absolute difference 23% {CI 11% to 35%}*, P < 0.001).

Conclusion

A computer-generated reminder chart increased patient knowledge of and compliance with their prescribed drug regimen for patients taking between 2 and 6 medicines at hospital discharge.

Source of funding: Yorkshire Regional Health Authority.

For article reprint: Dr. D.K. Raynor, Head of Division of Academic Pharmacy Practice, University of Leeds, Clarendon Wing, Belmong Grove, Leeds LS2 9NS, England, UK. FAX 44-113-292-6860.

* Numbers calculated from data in article.


Commentary

This elegant, well-designed clinical trial confirms that printed instructions in the form of a simple medication reminder chart can increase patient knowledge and medication compliance. Raynor and colleagues wrote a computer program to transfer prescription labeling information from a hospital pharmacy computer to the patient's medication chart, quickly producing an accurate and inexpensive medication reminder chart for patients at discharge. The single-page chart listed all long-term medication names and dosages and related the dosing interval to the patient's meals and bedtime.

The reminder chart improved patient knowledge of medication name, dose, and dose interval and substantially increased compliance as measured by pill count 10 days after hospital discharge. The 10-day follow-up is a short interval, but short-term compliance is a step toward long-term medication compliance. Interestingly, no statistically significant differences were seen in knowledge or compliance between a brief nursing medication review and a structured review by a pharmacist.

Because the computer program used existing computerized prescription data to generate the medication chart, the cost of the intervention was minimal. Prescription data are widely available in pharmacy computers, and applying these results to hospitals should not be difficult or expensive. Although not tested in ambulatory-care practice, a medication chart could be very useful if patients patronize a single pharmacy, such as in clinic or health maintenance organization settings, or in medical practices using computerized records or patient tracking programs.

Medication compliance will be maximized by a number of factors: patient belief in the efficacy of therapy, a strong physician-patient relationship, simple medication regimens, and minimal deleterious medication effect on quality of life. This study shows that an inexpensive computer application can also enable patients to substantially improve compliance with often complex medication regimens.

William P. Moran, MD
James L. Wofford, MDBowman Gray School of MedicineWinston-Salem, North Carolina, USA