Digital Applications Targeting Medication Safety In Ambulatory High-Risk Ckd Patients Randomized Controlled Clinical Trial

Background and objectives Patients with CKD are at risk for adverse drug reactions, but effective communitybasedpreventiveprograms remainelusive. Inthis study, we comparedthe effectivenessof two digital applications designed to improve outpatient medication safety. Design, setting, participants, & measurements In a 1-year randomized controlled trial, 182 outpatients with advanced CKD were randomly assigned to receive a smartphone preloaded with either eKidneyCare (n589) or MyMedRec (n593). The experimental intervention, eKidneyCare, includes a medication feature that prompted patients to review medications monthly and report changes, additions, or medication problems to clinicians for reconciliation and early intervention. The active comparator was MyMedRec, a commercially available, standalone application for storing medication and other health information that can be shared with patients' providers. The primary outcome was the rate of medication discrepancy, defined as differences between the patient's reported history and the clinic's medication record, at exit. Results At exit, the eKidneyCare group had fewer total medication discrepancies compared with MyMedRec (median, 0.45; interquartile range, 0.33-0.63 versus 0.67; interquartile range, 0.40-1.00; P50.001), and the change from baseline was 0.1360.27 in eKidneyCare and 0.3060.41 in MyMedRec (P50.007). eKidneyCare use also reduced the severity of clinically relevant medication discrepancies in all categories, including those with the potential to cause serious harm (estimated rate ratio, 0.40; 95% confidence interval, 0.27 to 0.63). Usage data revealed that 72% of patients randomized to eKidneyCare completed one or moremedication reviews permonth, whereas only 30% of patients in the MyMedRec group (adjusted for dropouts) kept their medication profile on their phone. Conclusions In patientswho are high risk and haveCKD, eKidneyCare significantly reduced the rate and severity of medication discrepancies, the proximal cause of medication errors, compared with the active comparator.