Promoting Health Literacy for Newly Prescribed Medications via the EMR

说明(由申请人提供)：这项研究的总体目标是通过分发由电子病历生成的“增强打印”说明来提高患者对新开的药物的理解和使用。在美国每年发生的150万起药物不良事件中，超过三分之一发生在门诊。患者用药信息来源不足被特别列为主要根本原因，因为患者可能由于对说明的不正确理解而无意中滥用处方药(Rx)。研究表明，医生经常错过就如何服用处方药向患者提供充分咨询的机会。处方也写得含糊其辞，拉丁语缩写和/或剂量频率表很容易被误解。药房将这些医生的处方转录到Rx标签上，然后再将其发送给患者。由于只有有限的州/联邦法规，药房对处方的解释可能会有很大差异。在配药时，药剂师不会常规地向患者提供咨询，Rx药物附带的打印材料以及药瓶标签的书写方式不清楚，许多患者很难理解。需要干预措施来标准化和整合目前支离破碎的患者用药信息系统。我们将在处方时开发和现场测试简短、可理解的说明，以便更好地向患者提供有关新药的信息。利用电子病历(EMR)，‘sig’消息(又名剂量说明)，将预先设置，以便所有医生以同样清晰、简单和精确的方式开出剂量、频率和持续时间。“方便用户”的处方将通过电子病历生成，并分发给服用新药的患者。这种在开处方时有针对性的电子病历策略将能够确认患者收到了足够的药物信息，可能会刺激医生咨询，并减少药店处方标签上的可变性。研究的目的是：1)试行测试和完善电子病历协议，以生成和分发新开药物的“增强型打印”患者说明；2)评估“增强型打印”说明与当前护理标准相比，提高患者对新开药物的理解的有效性；3)调查“增强型打印”患者说明对患者满意度、医生行为和药房标签的影响。循证的“签名”信息、警告和其他说明将与一家普通内科诊所的100种最常开出的药物联系起来。在临床广泛使用之前，将对EMR(EPIC)接口进行编程、试行协议并对其进行“除错”。在推出改进的EMR方案之前，将收集患者对新开出的药物的了解程度的基线比率。使用新处方的患者将收到带有增强打印处方说明的就诊总结表格。三个月后将再次评估患者在临床上对Rx的了解程度。这些患者还将被问及他们的处方填写情况、医生接触情况以及对强化指导的满意度。公共卫生相关性：拟议的研究是通过使用卫生信息技术建立一个标准的、集成的明确和实用的患者用药信息系统来提高用药安全性的重要的第一步。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.