Optimizing Medication History Value in Clinical Encounters with Elderly Patients

在开处方时提供用药史的电子处方可能会很有帮助 医生更充分地了解老年患者的依从性问题，从而促进 与患者建立伙伴关系，使患者能够参与治疗决策，并进行谈判 可接受的药物治疗方案，更适合患者随访。信息 对于社区药房连锁机构实时提供的用药史， 以及当处方未被填写时来自药房的通信的可能性， 目前在选定的地理位置的一些电子处方系统中可用。源于 我们之前的研究假设，为了优化药物质量的改善， 在临床医生办公室访问期间，临床医生需要额外的专业发展， 更好地利用用药史在临床遇到。我们还假设额外的 临床信息学必须与通过电子处方提供的详细用药史流程结合使用 帮助指导和组织临床医生？的药物管理方法， 门诊设置。具体目标是： 1.开发针对老年人的算法，以识别药物治疗的潜在问题 管理（例如，多种用药、潜在不适当的药物使用、重复治疗、不依从） 使用社区药房生成的药物历史。 2.对于在aim 1中开发的算法所识别的常见问题， 访视期间组织用药史信息的问题导向框架（触发）。 3.开发和预测试模块，以指导临床医生如何提高老年患者提供者 与使用技术进行药物管理相关的沟通（培训）。 4.为了测试这些干预措施对临床医生行为的影响，使用随机对照 三组试验：a）无干预，B）输送触发干预; c）输送触发 培训干预。 5.开发一个“工具包”资源，包括已开发的干预产品，供非医生使用 其他门诊环境中的提供者（例如社区药房环境中的药剂师）。

E-prescribing with medication history at the point of prescribing may very well assist physicians in understanding more fully adherence issues with older patients, thus promoting partnership with patients, empowering patients to participate in treatment decisions, and negotiating acceptable medication regimens that are more amenable to patient follow-through. Information regarding medication history provided by community pharmacy chain organizations in real-time, as well as the potential for communication from the pharmacy when a prescription has not been filled is currently available in some e-prescribing systems in selected geographic locations. Stemming from our previous research, we hypothesized that to optimize improvements in quality of medication management in during clinician office visits clinicians need additional professional development to better use the medication history in the clinical encounter. We also hypothesized that additional clinical informatics must be used in conjunction with the flow of detailed medication history via eprescribing to help guide and structure the clinician?s approach to medication management in ambulatory settings. The Specific Aims are: 1. To develop geriatric-specific algorithms to identify potential issues with medication management (e.g. polypharmacy, potentially inappropriate medication use, duplicative therapy, nonadherence) using community-pharmacy generated medication history. 2. For common issues identified by the algorithms developed in aim 1, to develop structured, problem-oriented frameworks for organizing medication history information during visits (triggering). 3. To develop and pretest modules to teach clinicians how to improve geriatric patient-provider communication relating to medication management with the use of technology (training). 4. To test the impact of these interventions on clinician behavior using a randomized controlled trial with three arms: a) no intervention, b) delivery triggering intervention; and c) delivery of triggering and training interventions. 5. To develop a "tool-kit" resources that include developed intervention products for use by nonphysician providers in other ambulatory settings (e.g. pharmacists in community pharmacy settings).