Physician's Dilemna: Pro-active Patient Management or Reactive Treatment Only

In my last post, I discussed some of Mr. G's experiences with the VA. See here.
Mr. G's main problem was that he had stopped taking his medications. FYI, Mr. G gets his medications shipped to him from the VA for only a few dollars per prescription. The VA has an EMR (electronic medical record) of when the last time he reordered his prescriptions. His GP was able to see he had not reordered his prescriptions for some time. (When I went into his apartment to do an intervention in ~February 2012, he had a prescription which had expired in 2008! Needless to say, I threw out all of his expired meds and had to schlep to the West Side VA Hospital to pick up all of his meds so that he would begin his blood pressure meds immediately. Reminder, his blood pressure was ~200/130.)

Medical adherence/medical compliance (meaning does the patient follow the physician's advice)  is a field where a lot of important research needs to be done to determine how to enable patients to better follow their physician's advice so that hopefully they will be able to lead healthier and longer lives. Once more is understood about the interaction between the physician and the patient, and how the physicians can best convey the information to different types of patients (i.e. visual learners vs. audatory learners vs. kinesthetic learners),best practices in the field of doctor patient communication could hopefully be quickly diffused throughout the medical profession. On the most basic level, an after visit summary is a piece of paper which tells the patient what happened to them and what are they supposed to do when they go home. I assume this increases medical adherence to a certain extent.

But back to Mr G. The VA's EMR system showed that it had been a really, really long time since Mr. G had reordered his medications. Does the VA's EMR system have built in alerts to let his GP know that Mr. G is overdue in ordering his meds? Does Mr. G's GP notice while he examines Mr. G and looks at the computer that he has not reordered his meds? Or is it completely the patients responsibility to reorder his meds and the physician should take a laissez-faire approach to whether their patients are ordering their meds? Or does it depend on the sophistication of the patient...meaning that regarding a patient who is of sound mind the doc should take a hands-off approach towards medical adherence but regarding an elderly patient with the beginnings of dementia, the doc should take a proactive approach in assuring the patient's medical adherence.

Finally, since shortly after Mr. G's sky high blood pressure incident, the VA sends a nurse once or twice a week to lay out his pills in a pill container and check to make sure all of the boxes are empty (so that it can be assumed he actually took the meds and didn't discard them in some other manner.) Also, she takes his blood pressure to ascertain whether his bp is in check so that it can be assumed with more evidence to back it up that he really has swallowed his pills. (Personally, I benefit from this practice because the first few weeks after the incident I needed to lay out his pills and go upstairs to his apartment every day to make sure he really took his meds. Now, Kate, the nurse does everything.)
It is possible the VA will eventually stop sending the nurse at some point (to save money) like it stopped sending the therapist at a certain point.
 I think an interesting study the VA can do is to enroll patients in automatic prescription ordering (like Walgreens has) so that their patients always have their meds and determine if this increases those patients medical adherence to taking their meds. Another study the VA can do is whether sending the patients meds already laid out in the weekly pill containers will improve medical adherence because I can attest to the fact that Mr. G cannot lay out his pills correctly so even of the VA would automatically send the meds, I doubt he would end up taking them correctly.