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Appl Clin Inform 2020; 11(03): 405-414
DOI: 10.1055/s-0040-1712467
Research Article
Georg Thieme Verlag KG Stuttgart · New York

Clinicians' Values and Preferences for Medication Adherence and Cost Clinical Decision Support in Primary Care: A Qualitative Study

Shubha Bhat
1   Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado, United States
,
Catherine Grace Derington
1   Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado, United States
2   Department of Pharmacy, Kaiser Permanente Colorado, Aurora, Colorado, United States
,
Katy E. Trinkley
1   Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado, United States
3   Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States
› Author Affiliations Funding This work was supported by the Colorado Clinical and Translational Science Institute (CTSA UL1 TR001082).
Further Information

Publication History

28 January 2020

13 April 2020

Publication Date:
03 June 2020 (online)

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Abstract

Background Medication nonadherence and unaffordability are prevalent, burdensome issues in primary care. In response, technology companies are capitalizing on clinical decision support (CDS) to deliver patient-specific information regarding medication adherence and costs to clinicians using electronic health records (EHRs). To maximize adoption and usability, these CDS tools should be designed with consideration of end users' values and preferences.

Objective This article evaluates primary care clinicians' values and preferences for a medication adherence and cost CDS.

Methods We conducted semistructured interviews with primary care clinicians with prescribing privileges and EHR access to identify clinicians' perceptions of and approaches to assessing medication adherence and costs, and to determine perceived values and preferences for medication adherence and cost CDS. Interviews were conducted until saturation of responses was reached. ATLAS.ti was used for thematic analysis.

Results Among 26 clinicians interviewed, themes identified included a high value, but moderate need for a medication adherence CDS and high value and need for cost CDS. Clinicians expressed the cost CDS would provide actionable solutions and greatly impact patient care. Another theme identified was a desire for medication adherence and cost CDS to be separate tools yet integrated into workflow. The majority of clinicians preferred a medication adherence CDS that integrated claims data and actively displayed data using color-coded adherence categories within patients' medication lists in the EHR. For the cost CDS, clinicians preferred medication out-of-pocket costs and a list of cheaper or payor-preferred alternatives to display within the order queue of the EHR.

Conclusion We identified valuable insights regarding clinician values and preferences for medication adherence and cost CDS. Overall, primary care clinicians feel CDS for medication adherence and cost are valuable and prefer them to be separate. These insights should be used to inform the design, implementation, and EHR integration of future medication and cost CDS tools.

Keywords

clinical decision support - medication adherence - medication costs - perceptions - primary care - medication - informatics

Protection of Human and Animal Subjects

The study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects.


 

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