Optimizing Medication History Value in Clinical Encounters with Elderly Patients

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E-prescribing with medication history at the point of prescribing may very well assist physicians in understanding more fully adherence issues with older patients, thus promoting partnership with patients, empowering patients to participate in treatment decisions, and negotiating acceptable medication regimens that are more amenable to patient follow-through. Information regarding medication history provided by community pharmacy chain organizations in real-time, as well as the potential for communication from the pharmacy when a prescription has not been filled is currently available in some e-prescribing systems in selected geographic locations. Stemming from our previous research, we hypothesized that to optimize improvements in quality of medication management in during clinician office visits clinicians need additional professional development to better use the medication history in the clinical encounter. We also hypothesized that additional clinical informatics must be used in conjunction with the flow of detailed medication history via eprescribing to help guide and structure the clinician?s approach to medication management in ambulatory settings. The Specific Aims are: 1. To develop geriatric-specific algorithms to identify potential issues with medication management (e.g. polypharmacy, potentially inappropriate medication use, duplicative therapy, nonadherence) using community-pharmacy generated medication history. 2. For common issues identified by the algorithms developed in aim 1, to develop structured, problem-oriented frameworks for organizing medication history information during visits (triggering). 3. To develop and pretest modules to teach clinicians how to improve geriatric patient-provider communication relating to medication management with the use of technology (training). 4. To test the impact of these interventions on clinician behavior using a randomized controlled trial with three arms: a) no intervention, b) delivery triggering intervention; and c) delivery of triggering and training interventions. 5. To develop a "tool-kit" resources that include developed intervention products for use by nonphysician providers in other ambulatory settings (e.g. pharmacists in community pharmacy settings).