Personal Health Records and Elder Medication Use Quality

描述（由申请人提供）：居住在社区的老年人使用药物远未达到最佳状态。药物错误包括过度使用、使用不足和滥用是常见的。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，通过改善服用多种药物的多种慢性疾病高风险患者的药物使用来优化治疗结果。MMA没有规定保健计划应如何提供MTM，而且存在各种提供方法。无论采用何种方式，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）系统的特点与这些关键的患者行为是平行的，并且理论上可以增强这些关键的患者行为。通过增强患者MTM行为，从理论上讲，PHRs可以增强患者与提供者的沟通和护理的连续性，反过来，医生可以更好地开处方，患者可以更好地遵守药物治疗。最终，增强患者MTM行为的预期健康效益是提高治疗效果和减少不良反应。拟议的研究是爱荷华大学（UI）老年人治疗学教育和研究中心（爱荷华CERT）和爱荷华研究网络（IRENE）的合作，爱荷华研究网络是10个AHRQ初级保健实践研究网络（PBRN）之一。我们建议在老年人中进行一项随机对照试验，研究当前具有代表性的PHR系统对患者报告的MTM行为、药物信念、药物使用质量指标和药物依从性的影响。我们还将研究PHR影响患者MTM行为的机制。我们的理论是，成功地保持PHR可以增强MTM的自我效能，保持PHR更新的行为可以增加患者对药物的了解，并且通过使用PHR获得的信息可以使患者将他们对药物的信念从关注转向必要性。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，在人机交互实验室中，我们将通过参与式设计与不同能力水平的老年人开发的替代原型来研究试验PHR系统的可用性。

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.