EMR Discrepancies May Affect Glaucoma Medication Adherence

Glaucoma patients typically have ever-changing drug therapy regimens involving multiple eye drop products.

In addition to these complex regimens, inconsistent documentation in glaucoma patients’ electronic medical records (EMRs) plays a role in their medication adherence.

In a new study published in the January 2016 issue of Clinical Ophthalmology, researchers from Boston University School of Medicine explored glaucoma medication nonadherence that was identified at reconciliation in a system using EMRs. The researchers were concerned that prescribers might find it difficult to update EMRs with medication changes, causing the records to be incomplete or inaccurate.

The researchers retrospectively examined 200 EMRs belonging to new and established glaucoma patients receiving medications from 3 ophthalmologist prescribers. They compared the physician- and patient-stated regimen with the EMR’s active medication list in order to find discrepancies.

The researchers found that the physician-stated regimen matched the EMR list in 80% of cases (160 of 200 patients), which was comparable to the patient-stated adherence rate (83.1%).

Twenty percent of medication reconciliation printouts listed medications with instructions that were incorrect based on the ophthalmologists’ treatment plans.

Twenty-nine of 40 discrepancies were identified between the EMRs and the patient’s actual regimen. The researchers also found 8 discrepancies in the physicians’ and EMRs’ medication list, and 3 patients were taking the EMRs’ documented medications that differed from the physician-stated list.

Most patients (72.5%) followed their physicians’ instructions instead of their printed medication list, and were taking their medications correctly. The researchers found that 7.25% of patients followed the printed regimen and took their medications incorrectly.

Patient sex, spoken language, regimen complexity, and race had no impact on glaucoma medication adherence rate in the study, though the researchers indicated that it may have been underpowered to detect the impact of language on adherence.

The researchers also stated that ophthalmologists should consider self-sufficiency, ease of drop administration, and forgetfulness as barriers to adherence among patients older than 80 years. Incorporating visual tools helps elderly patients and those with limited English proficiency improve their adherence.