Adverse Reaction to Drug, Health Behavior, Medication Adherence, Physician-Patient Relations
Conditions
Keywords
Personal health record, medication management, patient safety
Brief summary
Purpose: To examine the impact of a personal health record (PHR) on medication use safety among older adults. Background: Online PHRs have potential as tools to manage health information. We know little about how to make PHRs accessible for older adults and what effects this will have. Methods: A PHR was designed and pretested with older adults and tested in a six-month randomized controlled trial. After completing mailed baseline questionnaires, eligible computer users aged 65 and over were randomized 3:1 to be given access to a PHR (n=802) or serve as a standard care control group (n=273). Follow-up questionnaires measured change from baseline medication use, medication reconciliation behaviors, and medication management problems.
Interventions
BEHAVIORALPersonal Health Record (PHR)
Iowa PHR is a Web-based application that features a tabbed interface design. Users can enter, view, and print their current and past medicines, allergies, health conditions, and health event tracking over time. An embedded tutorial video provides assistance with the system. The PHR was developed and refined using participatory design and focus group sessions as well as evaluation in a usability laboratory. The resulting design emphasizes the reduction of physical and cognitive demands on users, focusing on simplicity, readability, and quick navigation. Iowa PHR displayed a message when a user entered a medication with an associated Assessing Care of Vulnerable Elders project (ACOVE-3) safety concern. This included 16 safety issues for 12 drugs or drug classes with safety concerns. We also adapted four general medication use patient safety indicators from the ACOVE project and displayed them to all users on a rotating basis upon login.
Sponsors
University of Iowa
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
65 Years to 95 Years
Healthy volunteers
No
Inclusion criteria
* Computer use within the past month. * Age 65+
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Mean (SD) number of prescription drugs | Baseline and 6 months | — |
| Mean (SD) number of over-the-counter drugs | Baseline and 6 months | — |
| Any change in medication use in past 3 months | Baseline and 6 months | — |
| Started prescription drug | Baseline and 6 months | — |
| Stopped prescription drug | Baseline and 6 months | — |
| Changed strength/dose of prescription drug | Baseline and 6 months | — |
| Keep list of current medications | Baseline and 6 months | — |
| Reason for medications on list | Baseline and 6 months | — |
| Usually shows medication list to doctor | Baseline and 6 months | — |
| Put over-the-counter drugs on list | Baseline and 6 months | — |
| Updated list in past 3 months | Baseline and 6 months | — |
| At last doctor visit, asked whether keep a medication list | Baseline and 6 months | — |
| At last doctor visit, had medication list | Baseline and 6 months | — |
| At last doctor visit showed medication list | Baseline and 6 months | — |
| Someone asked about medication strength at last doctor visit (for all medications) | Baseline and 6 months | — |
| Someone asked about medication strength at last doctor visit (for some medications) | Baseline and 6 months | — |
| At last doctor visit, doctor compared records with what patient said they were taking | Baseline and 6 months | — |
| At last doctor visit, differences found between doctor and patient medication records | Baseline and 6 months | — |
| Use of potentially inappropriate medications (ACOVE) | Baseline and 6 months | List of potentially inappropriate medications derived from the Assessing Care of Vulnerable Elders project (ACOVE-3) Shrank WH, Polinski JM, Avorn J. Quality Indicators for Medication Use in Vulnerable Elders. J Am Geriatr Soc 2007;55:S373-S382. |
| Taking 2 or more NSAIDS (including aspirin) | Baseline and 6 months | — |
| Mean (SD) number of medication management problems | Baseline and 6 months | — |
| Knows how to recognize side effects | 6 months | — |
| Medication side effects in past 3 months | Baseline and 6 months | — |
| Mean (SD) modified Morisky adherence score | Baseline and 6 months | — |
Countries
United States
Outcome results
None listed