Medtable: An EMR Strategy to Promote Patient Medication Understanding and Use

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DESCRIPTION (provided by applicant): The broad goal of this project is to improve knowledge of and adherence to medication regimens and health outcomes among adults with type 2 diabetes or other metabolic disorders. These patients have complex self-care needs, but limited literacy and cognitive skills to meet these needs. Medication error in ambulatory settings is widespread and costly, and often associated with inadequate patient knowledge about medication, especially among chronically ill adults with limited health literacy. Inadequate knowledge is often traced to limited communication with providers, in part because of barriers such as limited patient contact time and communication training, and lack of system-level support for consistent use of patient-centered strategies. There is a need to leverage information technology (IT) to provide system-based support for patient-centered communication. We will evaluate an Electronic Medical Record (EMR)-based tool (the Medtable) to support provider/patient communication and improve medication knowledge, adherence, and health outcomes among chronically ill adults with complex medication regimens. A paper-based Medtable has been found to help older adults create accurate medication schedules in a simulated patient/provider communication task (Morrow et al., 2008). Benefits for patients should be enhanced if the Medtable is integrated with an EMR, giving providers ready access to relevant background information and current medication lists that patients can update, so providers can generate and tailor the Medtable for a diverse set of patients. This system provides an integrated approach to patient education about medications, from prescribing to counseling during office visits. As a result, patients would not only understand how to take their medications, but develop concrete plans for doing so. Specific aims of the project are: 1) Refine the Medtable prototype for use in an EMR environment. This includes developing protocols for generating patient- specific Medtables and educating providers to use them in medical encounters. 2) Evaluate the Medtable's impact on patient care processes and outcomes. We test the following hypotheses about communication processes: H1) Nurses who work with patients supported by the Medtable will more likely use patient-centered communication strategies (e.g., provide complete information, check patient comprehension); H2) Patients in the intervention condition will be more satisfied with communication about medication. We also test the following hypotheses about patient outcomes. Compared to usual care patients, patients receiving the Medtable intervention will: H3) know more about their medications; H4) adhere more accurately to their medication regimens; H5) more likely have blood glucose (glycosylated hemoglobin, HbA1c) levels in the target range. Aim 1 will be accomplished by interviewing physicians and their patients as the system is refined to ensure ease of using the system, and by collecting preliminary evidence that the Medtable improves patient/provider communication. After establishing initial feasibility and ensuring provider acceptance of the system, Aim 2 is addressed by a randomized trial at the general internal medicine clinics in Chicago and Peoria (IL), comparing patients who use the Medtable with their providers to those receiving usual care. PUBLIC HEALTH RELEVANCE: Findings from this project will help integrate health literacy models with models of patient/provider communication and language comprehension in order to guide development of an IT-based tool (the Medtable) that supports the patient/provider communication needed to improve patient knowledge, adherence, and health outcomes. We focus on older adults with type 2 diabetes, complex medication regimens, and limited health literacy skills, because they are most in need of system-based support. The Medtable supports consistent use of patient- centered communication and counseling strategies at the point of prescribing medications, with the potential to integrate these practices with medication dispensing to create an integrated patient-centered medication use system. Such a system should mitigate the impact of inadequate health literacy on patients' health behaviors and outcomes.