Medication decisions are the most common type of decision that physicians in the outpatient setting make. Yet, the cumulative evidence over 25 years of study with varying methodologies, consistently demonstrate the ?relative poverty? of discussions between patients and providers regarding medications during medical encounters in primary care settings. It should come as no surprise that the incidence of adverse drug events has been estimated to be 27.4% amongst community dwelling adults and the financial burden of preventable ADE?s among Medicare recipients in the ambulatory setting is at least $887 million dollars. Furthermore, between 40% to 75% of older persons have difficulty taking medication as prescribed and estimates of the costs of poor adherence to medications have been ~$100 billion dollars per year. It follows that a panel of geriatric experts has ranked drug therapy management as the top condition in need of targeted improvement in the elderly. The availability of access to electronic medication history at the point of prescribing via electronic prescribing applications may very well assist physicians in understanding more fully medication management issues that older patients experience. Comprehensive and accurate electronic medication history provides the opportunity to create a tailored interventions based on the particular medication issues a patient may be experiencing. We hypothesize that electronic medication history can be harnessed to develop tailored patient education DVDs and print materials for low-literate audiences to empower geriatric patients and their caregivers to participate in treatment decisions and negotiate acceptable medication regimens that are more amenable to follow-through. The proposed research focuses on developing and testing interventions that seek to improve the patient experience of care through health information technology, improved shared decision making and patient-clinician communication, as well as self-management of chronic conditions.
The specific aims are:1) To develop algorithms to identify potential medication management issues based on communitypharmacy generated electronic medication history of elderly persons in census areas with high concentrations of minorities and poor people;2). To develop tailored print materials based on electronic medication history to assist geriatric patients in adhering to complex medication regimens;3). To develop tailored instructional videos which focus on improving the geriatric patient?s role in patient-provider communication regarding medication issues and adherence to medication regimens;4). To pre-test these interventions as part of a feasibility study within physician offices likely to service low literate geriatric patients.
