EHR-based Health Literacy Strategy to Promote Medication Therapy Management

描述（由申请人提供）：我们将评估两种基于初级保健的药物治疗管理策略，这些策略利用电子健康记录来促进患者对安全网诊所高血压和糖尿病患者的了解，药物调节，药物依从性和疾病控制。患有多种慢性疾病的患者使用复杂的药物治疗方案，但许多人，特别是那些读写能力有限的人，在执行常规药物治疗任务方面存在困难。随着医疗保险D部分的引入，药物治疗管理（MTM）作为一项授权，帮助许多老年患者安全地使用他们的方案。根据目前的定义，MTM包括药物审查、个人用药记录的汇编、药物相关行动计划的制定和随访。然而，MTM的初始模型大多与患者通常的护理来源（即药房）分开进行。这可能会限制其有效性；与药物有关的问题将由临床医生讨论，而不是完全了解患者处方者所打算的治疗方案。成本是MTM广泛使用的另一个障碍。我们的团队在一个学术内科实践中实地测试了嵌入电子健康记录（EHR）中的各种低读写能力MTM工具。在这项研究中，我们结合这些工具来解决MTM任务的全部范围。总的来说，我们将其称为基于电子健康记录的健康素养药物治疗管理干预，或“EHMI”。我们将评估EHMI策略的有效性，以提高1)患者对药物的理解，2)药物和解，3)方案依从性，以及4)在联邦合格医疗中心（fqhc）治疗的高血压+糖尿病患者的疾病控制。由于EHMI策略可能是充分的，也可能是不充分的，我们也将评估纳入护士教育，以帮助患者利用EHMI工具，提供简短的咨询，并跟踪进展。我们的具体目标是：1)测试EHMI策略的有效性，在有无护士教育者的情况下，与常规护理相比，以提高患者的理解、药物和解、依从性和健康结果；2)确定这些策略的效果是否因患者的读写技能而变化；3)评估两种策略的保真度，并探索影响干预的患者、员工、医生和卫生系统因素；4)评估实施该干预所需的成本。独家系统设计。我们将在12个fqhc进行一项三组临床随机试验，以评估EHMI和EHMI +护士教育干预措施。糖尿病和未控制的高血压患者将被招募并在3、6和12个月时再次评估。我们还将评估干预措施的保真度和经济影响，为今后的传播工作提供信息。

DESCRIPTION (provided by applicant): We will evaluate two primary care-based, medication therapy management strategies that leverage an electronic health record to promote, patient understanding, medication reconciliation, medication adherence and disease control among hypertensive and diabetic patients at safety net clinics. Patients with multiple chronic illnesses use complex medication regimens, yet many, especially those with limited literacy, have difficulty performing routine medication tasks. Introduced with Medicare Part D, medication therapy management (MTM) serves as a mandate to help many older patients safely use their regimen. As currently defined, MTM includes medication review, assembly of a personal medication record, development of medication-related action plans, and follow-up. However, initial models of MTM have mostly been performed separate from patients' usual source of care (i.e. pharmacies). This may limit its effectiveness; medication- related concerns would be discussed by clinicians not fully aware of the regimen intended by the patients' prescribers. Cost is yet another barrier to widespread use of MTM. Our team has field tested at one academic internal medicine practice various low literacy MTM tools embedded within the electronic health record (EHR). For this study, we combine these tools to address a full range of MTM tasks. In aggregate, we refer to this as an Electronic health record-based Health literacy Medication therapy management Intervention, or 'EHMI'. We will evaluate the effectiveness of the EHMI strategy to improve 1) patient medication understanding, 2) medication reconciliation, 3) regimen adherence, and 4) disease control among hypertensive + diabetic patients treated in federally qualified health centers (FQHCs). As the EHMI strategy may or may not be sufficient, we will also evaluate the inclusion of a nurse educator to help patients utilize EHMI tools, provide brief counseling, and track progress. Our specific aims are to: 1) Test the effectiveness of the EHMI strategy, with and without a nurse educator, to improve patient understanding, medication reconciliation, adherence, and health outcomes compared to usual care, 2) Determine if the effects of these strategies vary by patients' literacy skills, 3) Evaluate the fidelity of the two strategies and explore patient, staff, physician, and health system factors influencing the intervention, and 4) Assess the costs required to deliver this intervention, exclusive of system design. We will conduct a three-arm, clinic-randomized trial at 12 FQHCs to evaluate the EHMI and EHMI + Nurse Educator interventions. Patients with diabetes and uncontrolled hypertension will be recruited and assessed again at 3, 6, and 12 months. We will also assess the fidelity and economic impact of the interventions to inform future dissemination efforts.