Tailored DVD to Improve Medication Management for Low Literate Elderly Patients

药物决策是门诊医生最常见的决策类型。然而， 25年来采用不同方法进行的研究的累积证据一致表明， ?相对贫困？患者和医疗服务提供者之间关于医疗期间药物的讨论 在初级保健环境中的遭遇。药物不良事件的发生率 据估计，在社区居住的成年人中， ADE？在门诊医疗保险接受者中，至少有8.87亿美元。此外，委员会认为， 40%至75%的老年人难以按处方服药， 药物依从性差的成本每年约为1000亿美元。因此， 老年病专家将药物治疗管理列为需要有针对性改善的首要条件， 老人在通过电子处方时访问电子药物历史的可用性 处方应用可以很好地帮助医生更全面地理解药物管理 老年患者遇到的问题。全面准确的电子用药史提供了 有机会根据患者的特定药物问题创建定制的干预措施， 体验。我们假设电子药物史可以被利用来开发定制的患者 教育DVD和印刷材料，为低识字率的观众，使老年病人和他们的 护理人员参与治疗决策，并协商可接受的药物治疗方案， 服从于后续行动。拟议的研究重点是开发和测试干预措施， 通过健康信息技术改善患者的护理体验，改善共享决策， 制作和病人与临床医生的沟通，以及慢性病的自我管理。具体 目的是：1）开发基于社区药房的潜在药物管理问题识别算法 生成高浓度普查区老年人电子用药史 少数民族和穷人; 2）。开发基于电子用药历史的定制打印材料， 帮助老年患者坚持复杂的药物治疗方案; 3）.开发量身定制的 专注于改善老年患者的视频？在医患沟通中的作用 药物问题和药物治疗方案的依从性; 4）。为了预先测试这些干预措施， 在医生办公室内进行可行性研究，可能为识字率低的老年患者提供服务。

Medication decisions are the most common type of decision that physicians in the outpatient setting make. Yet, the cumulative evidence over 25 years of study with varying methodologies, consistently demonstrate the ?relative poverty? of discussions between patients and providers regarding medications during medical encounters in primary care settings. It should come as no surprise that the incidence of adverse drug events has been estimated to be 27.4% amongst community dwelling adults and the financial burden of preventable ADE?s among Medicare recipients in the ambulatory setting is at least $887 million dollars. Furthermore, between 40% to 75% of older persons have difficulty taking medication as prescribed and estimates of the costs of poor adherence to medications have been ~$100 billion dollars per year. It follows that a panel of geriatric experts has ranked drug therapy management as the top condition in need of targeted improvement in the elderly. The availability of access to electronic medication history at the point of prescribing via electronic prescribing applications may very well assist physicians in understanding more fully medication management issues that older patients experience. Comprehensive and accurate electronic medication history provides the opportunity to create a tailored interventions based on the particular medication issues a patient may be experiencing. We hypothesize that electronic medication history can be harnessed to develop tailored patient education DVDs and print materials for low-literate audiences to empower geriatric patients and their caregivers to participate in treatment decisions and negotiate acceptable medication regimens that are more amenable to follow-through. The proposed research focuses on developing and testing interventions that seek to improve the patient experience of care through health information technology, improved shared decision making and patient-clinician communication, as well as self-management of chronic conditions. The specific aims are:1) To develop algorithms to identify potential medication management issues based on communitypharmacy generated electronic medication history of elderly persons in census areas with high concentrations of minorities and poor people; 2). To develop tailored print materials based on electronic medication history to assist geriatric patients in adhering to complex medication regimens; 3). To develop tailored instructional videos which focus on improving the geriatric patient?s role in patient-provider communication regarding medication issues and adherence to medication regimens; 4). To pre-test these interventions as part of a feasibility study within physician offices likely to service low literate geriatric patients.