Personal Health Records and Elder Medication Use Quality

个人健康记录及长者用药质量

• 批准号: 7356321
• 负责人: Elizabeth A Chrischilles
• 金额: $ 41.97万
• 依托单位: UNIVERSITY OF IOWA
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-07 至 2010-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7356321
• 关键词: Personal; Health; Records; Elder; Medication

DESCRIPTION (provided by applicant): Use of medications by older adults living in the community is far from optimal. Medication errors including over-use, under-use, and misuse are common. The Medicare Modernization Act (MMA) of 2003 required plans to provide medication therapy management (MTM) services to optimize therapeutic outcomes through improved medication use among high risk patients with multiple chronic conditions taking multiple medications. The MMA did not dictate how health plans should deliver MTM and various delivery methods exist. Regardless of delivery method, a model of patient-centered MTM requires that the patient play a pivotal role that includes self-monitoring, self-evaluation, goal setting, and medication-taking. The features of a patient-controlled Personal Health Record (PHR) system parallel and are theorized to enhance these critical patient behaviors. By enhancing patient MTM behaviors, PHRs are theorized to result in enhanced patient-provider communication and care continuity and, in-turn, better prescribing by physicians and better medication adherence by patients. Ultimately, the expected health benefits of enhanced patient MTM behaviors are enhanced treatment effectiveness and reduced adverse effects. The proposed research is a collaboration of the University of Iowa (UI) Older Adults Center for Education and Research on Therapeutics (Iowa CERT) and the Iowa Research Network (IRENE), one of 10 AHRQ primary care practice-based research networks (PBRN). We propose a randomized controlled trial among older adults of the effect of a current representative PHR system on patient-reported MTM behaviors, beliefs about medications, medication-use quality indicators, and on medication adherence. We will also investigate the mechanisms through which PHR may affect the patient MTM behaviors. We theorize that successfully maintaining a PHR provides reinforcement to build self-efficacy for MTM, that the act of keeping a PHR up-to-date increases patient knowledge about medications, and that information gained through using the PHR allows patients to shift the balance of their beliefs about medication from concern toward necessity. Finally, we anticipate that some older adults will have difficulty using a PHR because the user interfaces for existing PHRs are designed for young adults. Declines in cognitive, perceptual and motor abilities among older adults are known to affect their use of computer technologies. Thus, in a human-computer interaction laboratory, we will investigate the usability of the trial PHR system against alternative prototypes developed through participatory design with older adults of varying ability levels.

描述（由申请人提供）：生活在社区的老年人使用药物远非最佳。用药错误，包括过度使用，使用不足和误用是常见的。2003年的医疗保险现代化法案（MMA）要求计划提供药物治疗管理（MTM）服务，以通过改善患有多种慢性病并服用多种药物的高风险患者的药物使用来优化治疗结果。MMA没有规定健康计划应该如何提供MTM，存在各种交付方法。无论采用哪种方式，以患者为中心的MTM模式都要求患者发挥关键作用，包括自我监测、自我评估、目标设定和服药。患者控制的个人健康记录（PHR）系统的功能并行，并从理论上增强这些关键的患者行为。通过增强患者的MTM行为，PHR理论上可以增强患者与提供者的沟通和护理连续性，进而改善医生的处方和患者的药物依从性。最终，增强患者MTM行为的预期健康益处是增强治疗有效性和减少不良反应。拟议的研究是爱荷华州大学（UI）老年人治疗学教育和研究中心（爱荷华州CERT）和爱荷华州研究网络（IRENE）的合作，IRENE是10个AHRQ基于初级保健实践的研究网络之一（PBRN）。我们提出了一个老年人的随机对照试验的影响，目前的代表PHR系统对患者报告的MTM行为，对药物的信念，药物使用质量指标，并对药物的依从性。我们还将调查PHR可能影响患者MTM行为的机制。我们的理论是，成功地保持PHR提供了强化，以建立自我效能的MTM，保持PHR最新的行为增加了患者对药物的知识，并通过使用PHR获得的信息允许患者转移他们的信念的平衡，从关注必要的药物。最后，我们预计一些老年人将难以使用PHR，因为现有PHR的用户界面是为年轻人设计的。众所周知，老年人认知、知觉和运动能力的下降会影响他们对计算机技术的使用。因此，在一个人机交互实验室，我们将调查的可用性试验PHR系统对替代原型开发通过参与式设计与不同能力水平的老年人。