For older adults, polypharmacy is a major safety issue with serious economic implications. Dr. Gerardo Moreno proposes research needed to investigate the use of health information technology (HIT) to improve medication management decision making for older adults in community health centers. The proposed Mentored Patient-Oriented Career Development Award will provide Dr. Moreno, a family medicine physician from UCLA, the resources to focus his research on aging and to obtain additional research training needed to become an independent principal investigator. The detailed research and career development experiences proposed aim to build upon his existing research skill set to gain needed expertise to: 1) develop his independence as a productive principal investigator in the area of Latino aging health disparities;2) further focus his research and gain significant expertise in aging-related issues;and 3) expand his qualitative research skills and implementation science skills. To achieve these goals, Dr. Moreno will complete course work, directed reading tutorials, and practical research experience. The career development activities also include mentorship and resources from the UCLA Resource Center for Minority Aging Research, a program devoted to eliminating disparities in health and health care among minority elders and to developing minority faculty who will be independently funded investigators who conduct aging research. Dr. Moreno's multidisciplinary mentorship team includes a health services researcher, social scientist, health informatics researcher, statistician with formal computer science training, and geriatrician. This proposal will use principles of community-based participatory research to build upon an established 4 year academic-community research partnership developed by the applicant with a large rural community health center. For older adults with multiple chronic conditions, polypharmacy can lead to increased use of potentially inappropriate medications and at the same time to the underutilization of medications known to improve health outcomes. Health (IT) tools may improve decision making for medication management but we know little about their application in community health centers and other safety-net settings. An overall objective of this proposal is to enhance Dr. Moreno's research skills and to conduct preliminary studies needed to develop health IT point-of-care (POC) decision support tailored to the prescription drug management needs of older adults in a safety-net system. Health IT POC clinical decision support in community health centers can be adopted by clinicians and hold great promise for improving the safety and quality of medication management for older adults when the end users of the system are incorporated into the research process from start to finish. Therefore, Dr. Moreno proposes research in partnership with a large rural community/migrant health center in California's impoverished San Joaquin Valley that serves two counties and has 22 clinical sites. His community partner's patient population is 72 percent Latino which is significant given the current and projected increase of elderly Latinos over the next few decades. To this end, the specific aims that focus on adults ? 60 years of age are: 1) to examine the prevalence and correlates of use of potentially inappropriate medications, 2) to examine how often there is suboptimal medication intensification of needed treatments for those with hypertension, diabetes, and dyslipidemias, 3) to identify provider, patient, and stakeholder barriers and facilitators (e.g. work flow issues and tailoring of message) to adoption of patient-centered health IT POC decision support designed to improve prescription drug management and safety, and 4) to adapt and develop a prototype of health IT POC decision support system for prescription drug management tailored to older adults with cardiovascular risk factors including hypertension, diabetes, and dyslipidemias.
Aims 1 -3 will inform the development and the decision support content and targeted messaging that is proposed in Aim 4. This research forms the basis for an R01 application of an adequately powered randomized clinical trial of health IT POC decision support to improve medication management quality and safety for older adults across a regional community clinic network.

Public Health Relevance

Older adults are at increased risk of using potentially inappropriate medications and paradoxically of under using treatments known to improve control of cardiovascular risk factors such as blood pressure. Health information technology (HIT) decision support to improve medication management delivered electronically during the patient visit holds great potential for decreasing use of potentially inappropriate medications and increasing the use of beneficial treatments. This project is grounded in an established community-based approach that will systematically include feedback from physicians, nurses, pharmacists, and patients so that the medication decision support tools developed are widely accepted and address the most important barriers for safe prescribing for older adults with chronic conditions.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Mentored Patient-Oriented Research Career Development Award (K23)
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Special Emphasis Panel (ZAG1-ZIJ-6 (M1))
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King, Jonathan W
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University of California Los Angeles
Family Medicine
Schools of Medicine
Los Angeles
United States
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Moreno, Gerardo; Morales, Leo S; Batts, Felicia et al. (2016) Migration, Health Care Behaviors, and Primary Care for Rural Latinos with Diabetes. J Immigr Minor Health 18:1247-52
Viramontes, Omar; Swendeman, Dallas; Moreno, Gerardo (2016) Efficacy of Behavioral Interventions on Biological Outcomes for Cardiovascular Disease Risk Reduction among Latinos: a Review of the Literature. J Racial Ethn Health Disparities :
Chung, Bowen; Brown, Arleen; Moreno, Gerardo et al. (2016) Implementing Community Engagement as a Mission at the David Geffen School of Medicine at the University of California, Los Angeles. J Health Care Poor Underserved 27:8-21
Moreno, Gerardo; Lin, Elizabeth H; Chang, Eva et al. (2016) Disparities in the Use of Internet and Telephone Medication Refills among Linguistically Diverse Patients. J Gen Intern Med 31:282-8
Goodfellow, Amelia; Ulloa, Jesus G; Dowling, Patrick T et al. (2016) Predictors of Primary Care Physician Practice Location in Underserved Urban or Rural Areas in the United States: A Systematic Literature Review. Acad Med 91:1313-21
Moreno, Gerardo; Morales, Leo S; Isiordia, Marilu et al. (2015) Latinos with diabetes and food insecurity in an agricultural community. Med Care 53:423-9
Ganjian, Sheila; Dowling, Patrick T; Hove, Jason et al. (2015) What physicians from diverse specialties know and support in health care reform. Fam Med 47:283-91
Moreno, Gerardo; Mangione, Carol M; Meza, Carlos E et al. (2015) Perceptions from latino and african american older adults about biological markers in research. Ethn Dis 25:355-62
Talamantes, Efrain; Moreno, Gerardo (2015) Immigration Policies and the U.S. Medical Education System: A Diverse Physician Workforce to Reduce Health Disparities. J Gen Intern Med 30:1058-9
Detz, Alissa; Mangione, Carol M; Nunez de Jaimes, Fatima et al. (2014) Language concordance, interpersonal care, and diabetes self-care in rural Latino patients. J Gen Intern Med 29:1650-6

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