Personal Health Records and Elder Medication Use Quality

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.

Study Overview

• Status: Completed
• Conditions: Medication Adherence; Health Behavior; Adverse Reaction to Drug; Physician-Patient Relations
• Intervention / Treatment: Behavioral: Personal Health Record (PHR)

• Study Type: Interventional
• Enrollment (Actual): 1163
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Iowa
    • Iowa City, Iowa, United States, 52242
      • University of Iowa

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 65 years to 95 years (Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Computer use within the past month.
• Age 65+

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Personal Health Record (PHR); Subjects were sent an invitation to use an online Personal Health Record (PHR)	Behavioral: Personal 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.
No Intervention: Usual care; Subjects received usual care (no invitation or access to the study PHR)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
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)	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.	Baseline and 6 months
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

Collaborators and Investigators

• Sponsor: University of Iowa
• Investigators: Principal Investigator: Elizabeth A Chrischilles, PhD, University of Iowa

Publications and helpful links

General Publications

• Hourcade, J.P., Chrischilles, E.A., Gryzlak, B.M., Hanson, B.M., Dunbar, D.E., Eichmann, D.A. and Lorentzen, R.R. (2011). Design Lessons for Older Adult Personal Health Records Software from Older Adults. Proceedings of 6th International Conference on Universal Access in Human-Computer Interaction, held as part of HCI International. Lecture Notes in Computer Science, 6766, 176-85.
• Witry MJ, Doucette WR, Daly JM, Levy BT, Chrischilles EA. Family physician perceptions of personal health records. Perspect Health Inf Manag. 2010 Jan 1;7(Winter):1d.
• Chrischilles EA, Hourcade JP, Doucette W, Eichmann D, Gryzlak B, Lorentzen R, Wright K, Letuchy E, Mueller M, Farris K, Levy B. Personal health records: a randomized trial of effects on elder medication safety. J Am Med Inform Assoc. 2014 Jul-Aug;21(4):679-86. doi: 10.1136/amiajnl-2013-002284. Epub 2013 Dec 10.

Helpful Links

• [Manuscript] Design Lessons for Older Adult Personal Health Records Software from Older Adults
• Project final report

Study record dates

Study Major Dates

• Study Start: July 1, 2010
• Primary Completion (Actual): February 1, 2011
• Study Completion (Actual): February 1, 2011

Study Registration Dates

• First Submitted: November 6, 2013
• First Submitted That Met QC Criteria: December 10, 2013
• First Posted (Estimate): December 16, 2013

Study Record Updates

• Last Update Posted (Actual): August 28, 2019
• Last Update Submitted That Met QC Criteria: August 26, 2019
• Last Verified: March 1, 2017

More Information

Terms related to this study

• Keywords: patient safety; medication management; Personal health record
• Additional Relevant MeSH Terms: Chemically-Induced Disorders; Drug-Related Side Effects and Adverse Reactions
• Other Study ID Numbers: 200708714; R18HS017034 (U.S. AHRQ Grant/Contract)