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
