Electronic Medication Adherence Reporting and Feedback During Care Transitions

护理过渡期间的电子药物依从性报告和反馈

• 批准号: 9265782
• 负责人: Jeffrey Lawrence Schnipper
• 金额: $ 14万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-05-01 至 2019-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9265782
• 关键词: Electronic; Medication; Adherence; Reporting; Feedback

 DESCRIPTION (provided by applicant): Adverse drug events are common during transitions from the hospital to the ambulatory setting, in part due to unintentional discrepancies in medication regimens and non-adherence with those regimes. The broad, long-term objectives of this research are to design, implement, and evaluate novel interventions to improve medication safety during transitions of care. The specific aims of the is study are to 1) Implement a smart pill-box intervention for patients discharged from the hospital to the community; 2) Evaluate the effects of the intervention on post-discharge medication discrepancies, medication adherence, and chronic disease management; and 3) Determine barriers and facilitators of implementation of the intervention. The design of this study is a cluster-randomized controlled trial, with clustering at the level of the primary care practice. Subjects will include randomly selected patients admitted to the medicine service of a large, urban hospital on 5 or more chronic medications and with a plan to be discharged to the community. The intervention will consist of a "smart pill-box" with pre-filled medication trays and several HIT features, including ability to send alerts to patients or caregivers by phone, email, or text if medication wells in the pillbox ae not accessed; and the generation of adherence reports accessible by patients, by caregivers (with patients' permission), and by providers by way of a link embedded within the electronic health record (EHR). Primary outcomes to be evaluated will include medication discrepancies between dispensed medications and the regimen documented in the EHR, and medication adherence based on prescription fill data, i.e., the proportion of days covered. Measures of disease control in patients with hypertension, hyperlipidemia, and diabetes mellitus will serve as secondary outcomes. We will also evaluate several measures of implementation of the intervention, such as the use of medication adherence reports by patients, caregivers, and providers. Multivariable regression with general estimating equations will be used to adjust for patient factors and account for clustering at the level of the primary care practice. Lastly, we wil conduct semi-structured qualitative interviews of a sample of patients, caregivers, and providers to learn more about the usability of the intervention and any barriers and facilitators of implementation. This study will advance the field of medication safety by quantifying the benefits of this type of intervention in the transitions setting, where it has not been previously evaluated and where there is demonstrable need for improvement.

 描述(由申请人提供)：在从医院过渡到门诊环境的过程中，药物不良事件很常见，部分原因是药物治疗方案的无意差异和不遵守这些方案。这项研究的广泛、长期目标是设计、实施和评估新的干预措施，以提高护理过渡期间的用药安全性。IS研究的具体目标是1)为出院患者实施智能药盒干预；2)评估干预对出院后用药差异、用药依从性和慢性病管理的影响；3)确定实施干预的障碍和促进者。这项研究的设计是一项整群随机对照试验，在初级保健实践的水平上进行整群。研究对象将包括随机选择的接受大型城市医院药物服务的患者，这些患者服用5种或更多的慢性药物，并计划出院到社区。干预措施将包括一个带有预先装满的药物托盘和几个热门功能的“智能药盒”，包括如果无法访问药盒中的药井，可以通过电话、电子邮件或文本向患者或护理人员发送警报；以及生成患者、护理人员(在患者允许的情况下)以及提供者通过电子健康记录(EHR)中嵌入的链接访问的依从性报告。要评估的主要结果将包括分配的药物与EHR中记录的方案之间的用药差异，以及基于处方填写数据的用药依从性，即覆盖的天数比例。高血压、高脂血症和糖尿病患者的疾病控制措施将成为次要结果。我们还将评估实施干预的几项措施，例如患者、照顾者和提供者使用药物依从性报告的情况。将使用带有一般估计方程的多变量回归来调整患者因素，并在初级保健实践的水平上考虑集群。最后，我们将对患者、照顾者和提供者进行半结构化的定性访谈，以更多地了解干预的可用性以及实施的任何障碍和促进者。这项研究将通过量化这种类型的干预在过渡期环境中的好处来推进药物安全领域，在这种情况下，它以前没有被评估过 以及明显需要改进的地方。