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

描述（由申请人提供）：该项目的总体目标是提高2型糖尿病或其他代谢紊乱患者对药物治疗方案的认识和依从性，以及健康结果。这些患者有复杂的自我护理需求，但满足这些需求的读写能力和认知能力有限。门诊用药错误普遍存在且代价高昂，而且往往与患者用药知识不足有关，特别是在卫生知识有限的成年慢性病患者中。知识不足通常可追溯到与提供者的沟通有限，部分原因是由于患者接触时间有限和沟通培训有限等障碍，以及缺乏对一贯使用以患者为中心的策略的系统级支持。有必要利用信息技术（IT）为以患者为中心的交流提供基于系统的支持。我们将评估基于电子病历（EMR）的工具（Medtable），以支持提供者/患者沟通，并改善患有复杂药物治疗方案的慢性成人患者的药物知识、依从性和健康结果。基于纸张的Medtable已经被发现可以帮助老年人在模拟患者/提供者沟通任务中创建准确的药物时间表（Morrow et al., 2008）。如果将Medtable与EMR集成在一起，使医疗服务提供者能够随时访问相关的背景信息和患者可以更新的当前药物清单，那么医疗服务提供者就可以为不同的患者生成和定制Medtable。该系统提供了一种综合的方法来对患者进行药物教育，从处方到就诊期间的咨询。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)细化Medtable原型，以便在EMR环境中使用。这包括制定生成针对患者的医疗表格的协议，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：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)处于干预状态的患者对用药沟通更满意。我们还检验了以下关于患者预后的假设。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方案；H5)更可能有血糖（糖化血红蛋白，HbA1c）水平在目标范围内。目标1将通过对医生及其患者的访谈来完成，因为该系统正在完善，以确保使用系统的便利性，并通过收集初步证据来证明Medtable改善了患者/提供者的沟通。在初步确定可行性并确保提供者接受该系统后，在芝加哥和皮奥里亚（伊利诺伊州）的普通内科诊所进行了一项随机试验，将与提供者一起使用Medtable的患者与接受常规护理的患者进行比较，从而解决了目标2。

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.