Promoting Health Literacy for Newly Prescribed Medications via the EMR

描述（由申请方提供）：本研究的总体目标是通过分发电子病历生成的“增强打印”说明，提高患者对新处方药物的理解和使用。在美国每年发生的150万起药物不良事件中，有三分之一以上发生在门诊。患者用药信息来源不足被特别引用为主要根本原因，因为患者可能由于对说明书的理解不当而无意中误用处方药（Rx）。研究表明，医生经常错过机会，充分咨询病人如何服用处方药。处方也写得很模糊，拉丁语缩写和/或剂量频率表很容易被误解。药房将这些医生处方转录到Rx标签上，然后直接发送给患者。由于只有有限的州/联邦法规，药房对处方的解释可能差异很大。在配药时，药剂师不会常规地为患者提供咨询，并且Rx药物的打印材料以及小瓶标签的书写方式不清楚，许多患者难以理解。需要采取干预措施，使目前分散的患者用药信息系统标准化和整合。我们将在处方时开发和现场测试简短，易于理解的说明，以便更好地告知患者新药。利用电子病历（EMR）、“sig”信息（也称为“sig”）剂量指示），将被预设，以便所有医生以相同的清晰、简单和精确的方式规定剂量、频率和持续时间。将通过电子病历生成“方便用户”的处方，并向患者分发新药。这种有针对性的EMR策略在处方点将能够确认患者收到足够的药物信息，可能会刺激医生咨询，并减少在药店之间的Rx标签上发现的变异性。研究目的是：1）试点测试和优化EMR协议，用于生成和分发新处方药物的“增强打印”患者说明，2）与当前护理标准相比，评估“增强打印”说明的功效，以提高患者对新处方药物的理解，3）调查“增强打印”患者说明对患者满意度，医生行为和药房标签的影响。基于证据的“sig”信息、警告和其他说明将与一个普通诊所的100种最常用的药物挂钩。EMR（Epic）界面将在诊所范围内使用之前进行编程、方案试验和“调试”。在推出完善的EMR方案之前，将收集患者对新处方药物的理解的基线率。使用新处方的患者将收到带有增强打印Rx说明的访视总结表。三个月后将再次评估门诊患者对Rx的理解率。这些患者还将被问及他们的处方，医生的遭遇，以及对增强指示的满意度。公共卫生相关性：拟议的研究是通过使用健康信息技术建立明确实用的患者用药信息的标准、集成系统来改善用药安全的重要第一步。这一系列研究的结果将直接为临床护理以及与药物标签和处方相关的州和联邦政策提供信息。

DESCRIPTION (provided by applicant): The overall objective of this study is to improve patient understanding and use of newly prescribed drugs via distribution of `enhanced print' instructions generated by the electronic medical record. More than one third of the 1.5 million adverse drug events that occur in the United States each year happen in outpatient settings. Inadequate sources for patient medication information were specifically cited as a leading root cause, as patients may unintentionally misuse a prescribed drug (Rx) due to improper understanding of instructions. Studies have shown that physicians frequently miss opportunities to adequately counsel patients on how to take prescribed medicines. Prescriptions are also vaguely written, with Latin abbreviations and/or dose frequency schedules that are easily misinterpreted. Pharmacies transcribe these physician prescriptions onto the Rx label, which is then directed to patients. With only limited state/federal regulations, pharmacy interpretations of prescriptions may widely vary. At dispensing, pharmacists do not routinely counsel patients, and print materials accompanying Rx drugs, as well as the vial label, are written in an unclear manner, and difficult for many patients to comprehend. Interventions are needed to standardize and integrate the current fragmented system of patient medication information. We will develop and field test brief, comprehendible instructions at the point of prescribing that will better inform patients about new medicines. Taking advantage of the electronic medical record (EMR), `sig' messages (a.k.a. dosage instructions), will be preset so all physicians prescribe dosage, frequency, and duration in the same clear, simple, and precise manner. `User- friendly' prescriptions will be generated via the EMR and distributed to patients with new medicines. This targeted EMR strategy at the point of prescribing will be able to confirm patients receive adequate drug information, may stimulate physician counseling, and reduce the variability found on Rx labels across pharmacies. Study aims are to: 1) Pilot Test and Refine an EMR protocol for generating and distributing `enhanced print' patient instructions for newly prescribed medicines, 2) Evaluate the efficacy of the `enhanced print' instructions to improve patient understanding of newly prescribed medicines compared to the current standard of care, 3) Investigate the effect of `enhanced print' patient instructions on patient satisfaction, physician behavior, and pharmacy labeling. Evidence-based `sig' messages, warnings and other instructions will be linked to the 100 most-prescribed medicines in one general medicine clinic. The EMR (Epic) interface will be programmed, protocol piloted, and `de-bugged' prior to clinic-wide use. Baseline rates of patient understanding of newly prescribed medicines will be collected prior to roll-out of the refined EMR protocol. Patients with new prescriptions will receive visit summary forms with enhanced print Rx instructions. Rates of patient Rx understanding in the clinic will again be assessed three months later. These patients will also be asked about their filled prescriptions, physician encounters, and satisfaction with enhanced instructions. Public Health Relevance: The proposed study is a significant first step towards improving medication safety through a standard, integrated system of clear and practical patient medication information using health information technology. Results from this line of research will directly inform clinical care and state and federal policies associated with drug labeling and prescribing.