Effects of Literacy on Medication Safety In the Elderly

说明(申请人提供)：老年人占美国处方药消费的三分之一，发生用药差错(MES)和药物不良事件(ADE)的风险更大。他们也更有可能具有较低的健康素养，这增加了与药物有关的问题的可能性。关于MES和ADE的数据主要是在医院收集的，在那里更容易监控此类错误并识别遇到与药物有关的问题的患者。这种方法在美国并不是最理想的，因为在美国，大多数药物都是由初级保健医生在门诊环境下开出的。这项拟议的研究将描述老年人的MES和ADE的谱，以及健康素养如何影响用药安全。该应用程序的目的是确定功能性健康素养(FHL)低(不足和边缘)的老年初级保健患者与功能性健康素养(FHL)充足的老年初级保健患者之间MES的频率、类型、严重性和可预防性。此外，我们将进行认知访谈，以了解为什么可能会发生MES。这项研究将在位于德克萨斯州休斯顿的南方初级保健城市研究网络(SPUR-NetSM)中进行。在这项申请中，我们建议评估来自不同种族和社会经济背景的300名老年患者使用的药物，他们是由门诊初级保健提供者看到的。这是一项独特的研究，因为我们的主要结果衡量标准是发生在初级保健诊所的ME；此外，我们将产生研究结果，并比较不同种族、社会经济地位和文化程度的老年患者的MES和ADE的类型和比率。这项研究的结果将被用于为初级保健诊所内实施和评估的药物安全促进教育计划设计干预措施。这项拟议的研究是创新的，因为它将提供对不同初级保健人群中的MES和ADE的理解，以及健康素养与此类错误的联系。这项拟议的研究的结果将是重要的，因为数百万美国老年人将得到更高质量的护理。

DESCRIPTION (provided by applicant): The elderly account for 1/3rd of prescription drug consumption in the United States and are at greater risk for medication errors (MEs) and adverse drug events (ADEs). They are also more likely to have low health literacy that increases the possibility of medication-related problems. Data on MEs and ADEs are collected predominantly in hospitals where it is easier to monitor such errors and to identify patients experiencing medication-related problems. This approach is not optimal in the United States, because here most medications are prescribed in the outpatient setting by primary care physicians. The proposed study will describe the spectrum of MEs and ADEs in the elderly and how health literacy affects medication safety. The aim of this application is to determine the frequency, type, severity, and preventability of MEs among elderly primary care patients who have low (inadequate and marginal) functional health literacy (FHL) vs. elderly primary care patients who have adequate FHL. Furthermore, we will conduct cognitive interviews to understand why MEs may have occurred. The study will be conducted in a primary care research network, the Southern Primary care Urban Research Network (SPUR-NetSM), which is located in Houston, Texas. In this application, we propose to evaluate medications used by 300 elderly patients from diverse ethnic and socioeconomic backgrounds who are seen by primary care providers in outpatient clinics. This is a unique study, because our main outcome measure is ME as it occurs in primary care clinics;. Moreover, we will generate findings and compare types and rates of MEs and ADEs among elderly patients who have different ethnicity, socioeconomic status, and literacy. Findings from this study will be used to design interventions for medication-safety-promotion education programs to be implemented and evaluated within primary care clinics. The proposed research is innovative, because it will provide an understanding of MEs and ADEs in a diverse primary care population and the association of health literacy with such errors. The outcomes of the proposed research will be significant, because millions of the American elderly will receive improved quality of care.