Adherence monitoring and intervention using a clinical decision support system in a pediatric gastroenterology clinic

Objectives To develop and evaluate the implementation, feasibility, and acceptability, and implementation of an electronic health record (EHR)‐based clinical decision support (CDS) tool addressing medication adherence, the Adherence Action Plan (A 2 P) , among youth with gastrointestinal (GI) conditions. Methods The A 2 P was developed, piloted, and implemented over 12 months for all patients seen in the GI Clinic of a Midwestern pediatric tertiary hospital. The A 2 P program comprised an adherence assessment followed by needs‐matched, evidence‐based solutions when the assessment indicated poor adherence. EHR analytics of clinical documentation was used to assess weekly provider use of A 2 P. At the end of the A 2 P implementation period, providers completed questionnaires assessing feasibility, usability, and perceived impact on clinical practice. Patients and families were surveyed regarding feasibility and perceived impact on medication‐taking behaviors. Results Among the 1110 encounters in which nonadherence was identified, 47% included documentation of A 2 P use. Providers documented modifying treatment plans to address adherence concerns in 71.4% of encounters and reviewing evidence‐based adherence strategies with families in 78.6%. Most families rated the A 2 P as feasible and reported improved knowledge and self‐efficacy related to medication adherence, with 86% reporting implementation of identified adherence‐focused interventions in their home. Provider ratings of the A 2 P tool indicated moderate feasibility ratings but below‐average usability scores. Conclusions The A 2 P is a promising CDS tool to support GI providers in identifying and addressing medication nonadherence. Future refinement efforts are needed to improve usability and workflow integration and to evaluate the tool's impact on adherence and clinical outcomes in adequately powered studies.