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对患有2型糖尿病或其他代谢紊乱的成年人对药物治疗方案和健康结果的了解和遵守。这些患者有复杂的自我护理需求，但识字和认知技能有限，无法满足这些需求。门诊环境中的用药错误普遍且代价高昂，往往与患者对药物的了解不足有关，特别是在健康素养有限的慢性病成年人中。知识不足通常被追溯到与提供者的沟通有限，部分原因是障碍，如有限的患者接触时间和沟通培训，以及缺乏系统层面的支持，无法一致地使用以患者为中心的策略。需要利用信息技术(IT)为以患者为中心的交流提供基于系统的支持。我们将评估一种基于电子病历(EMR)的工具(Medtable)，以支持提供者/患者的沟通，并改善使用复杂用药方案的慢性病成年人的用药知识、依从性和健康结果。一种基于纸张的Medtable已被发现在模拟的患者/提供者沟通任务中帮助老年人创建准确的用药时间表(Morrow等人，2008年)。如果Medtable与EMR集成在一起，患者的好处应该会得到增强，使提供商能够随时访问相关背景信息和患者可以更新的当前药物清单，这样提供商就可以为不同的患者生成和定制Medtable。这个系统提供了一种综合的方法来教育患者关于药物的知识，从开处方到在办公室就诊期间进行咨询。因此，患者不仅知道如何服药，还会制定具体的服药计划。该项目的具体目标是：1)改进Medtable原型，以便在EMR环境中使用。这包括开发用于生成特定于患者的Medtable的协议，并教育提供者在医疗接触中使用它们。2)评估Medtable对患者护理过程和结果的影响。我们检验了以下关于沟通过程的假设：1)与Medtable支持的患者合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)处于干预状态的患者将对有关药物的沟通更满意。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)更准确地坚持他们的药物治疗方案；H5)更有可能使血糖(糖化血红蛋白，HbA1c)水平处于目标范围。目标1将通过采访医生和他们的患者来实现，因为该系统经过改进，以确保系统的易用性，并通过收集Medtable改善患者/提供者沟通的初步证据来实现。在确定初步可行性并确保提供者接受该系统后，在芝加哥和皮奥里亚(IL)的普通内科诊所进行了一项随机试验，将使用Medtable和提供者的患者与接受常规护理的患者进行比较。 公共卫生相关性：该项目的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的模型相结合，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。我们专注于患有2型糖尿病、复杂的药物治疗方案和有限的健康素养技能的老年人，因为他们最需要基于系统的支持。Medtable支持在开药时始终如一地使用以患者为中心的沟通和咨询策略，并有可能将这些做法与药物分配相结合，创建以患者为中心的综合用药系统。这样的系统应该可以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.