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

描述（由申请人提供）：该项目的广泛目标是提高2型糖尿病或其他代谢紊乱成年人对药物治疗方案和健康结果的认识和依从性。这些患者有复杂的自我护理需求，但有限的识字和认知技能，以满足这些需求。在门诊环境中的用药错误是普遍的和昂贵的，往往与患者对药物的知识不足，特别是在慢性病患者的健康素养有限的成年人。知识不足通常可追溯到与提供者的沟通有限，部分原因是患者接触时间和沟通培训有限等障碍，以及缺乏系统层面的支持，无法始终如一地使用以患者为中心的策略。有必要利用信息技术（IT）为以患者为中心的沟通提供基于系统的支持。我们将评估基于电子病历（EMR）的工具（Medtable），以支持提供者/患者沟通，并改善具有复杂药物治疗方案的慢性病成人的药物知识，依从性和健康结果。已经发现基于纸张的Medtable可以帮助老年人在模拟的患者/提供者沟通任务中创建准确的药物计划（Morrow等人，2008年）。如果Medtable与EMR集成，则应增强患者的益处，使提供者能够随时访问患者可以更新的相关背景信息和当前药物列表，因此提供者可以为不同的患者生成和定制Medtable。该系统提供了一个综合的方法，病人教育有关药物，从处方到咨询，在办公室访问。因此，患者不仅会了解如何服用药物，而且会制定具体的计划。该项目的具体目标是：1）完善Medtable原型用于EMR环境。这包括制定生成患者特定医疗表的协议，并教育提供者在医疗接触中使用它们。2)评估Medtable对患者护理流程和结果的影响。我们测试了以下关于沟通过程的假设：H1）与Medtable支持的患者一起工作的护士更有可能使用以患者为中心的沟通策略（例如，提供完整的信息，检查患者的理解）; H2）干预条件下的患者对药物沟通的满意度更高。我们还测试了以下关于患者结局的假设。与常规护理患者相比，接受Medtable干预的患者将：H3）更多地了解他们的药物; H4）更准确地遵守他们的药物治疗方案; H5）更有可能使血糖（糖化血红蛋白，HbA 1c）水平在目标范围内。目标1将通过采访医生和他们的病人来实现，因为该系统是完善的，以确保易于使用该系统，并通过收集初步证据，Medtable改善病人/提供者的沟通。在建立了最初的可行性并确保提供者接受该系统后，目标2通过在芝加哥和皮奥里亚（IL）的普通内科诊所进行的随机试验来解决，比较使用Medtable的患者与他们的提供者接受常规护理的患者。 公共卫生相关性：该项目的研究结果将有助于将健康素养模型与患者/提供者沟通和语言理解模型相结合，以指导基于IT的工具（Medtable）的开发，该工具支持改善患者知识，依从性和健康结果所需的患者/提供者沟通。我们专注于2型糖尿病患者，复杂的药物治疗方案和有限的健康知识技能，因为他们最需要基于系统的支持。Medtable支持在开药时始终使用以患者为中心的沟通和咨询策略，并有可能将这些实践与药物分配相结合，以创建一个以患者为中心的综合药物使用系统。这样的系统应该减轻健康素养不足对患者健康行为和结果的影响。

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.