Optimizing Medication History Value in Clinical Encounters with Elderly Patients

在开处方时写上用药史的电子处方可能会很有帮助 医生更全面地了解老年患者的依从性问题，从而促进 与患者建立伙伴关系，赋予患者参与治疗决策的权力，并进行谈判 更易于患者随访的可接受的用药方案。信息 关于社区药房连锁组织实时提供的用药历史，如 以及当处方没有被配药时来自药房的通信的可能性是 目前在选定地理位置的一些电子处方系统中可用。源于 我们之前的研究假设，为了优化药物质量的改善 在临床医生办公室访问期间的管理临床医生需要额外的专业发展，以 在临床就诊中更好地利用用药记录。我们还假设了额外的 临床信息学必须与通过电子描述的详细用药病历流相结合 帮助指导和构建临床医生？S在《医院用药管理》中的做法 可移动设置。具体目标是： 1.开发针对老年人的算法，以识别潜在的用药问题 管理(例如，多药联用、潜在的不适当用药、重复治疗、不坚持) 使用社区药房会产生用药记录。 2.对于目标1中开发的算法所确定的常见问题，开发结构化的、 面向问题的框架，用于组织就诊期间的用药历史信息(触发)。 3.开发和预试模块，教导临床医生如何改善老年患者提供者 利用技术进行与药物管理有关的沟通(培训)。 4.采用随机对照的方法，检验这些干预措施对临床医生行为的影响 三个环节的试验：a)不干预，b)分娩触发干预；c)分娩触发 和培训干预。 5.开发“工具包”资源，包括已开发的干预产品，供非内科医生使用 其他流动环境中的提供者(例如社区药房环境中的药剂师)。

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).