Effects of a Patient-Provider, Collaborative, Medication-Planning Tool: A Randomized, Controlled Trial

James F Graumlich, Huaping Wang, Anna Madison, Michael S Wolf, Darren Kaiser, Kumud Dahal, Daniel G Morrow, James F Graumlich, Huaping Wang, Anna Madison, Michael S Wolf, Darren Kaiser, Kumud Dahal, Daniel G Morrow

Abstract

Among patients with various levels of health literacy, the effects of collaborative, patient-provider, medication-planning tools on outcomes relevant to self-management are uncertain. Objective. Among adult patients with type II diabetes mellitus, we tested the effectiveness of a medication-planning tool (Medtable™) implemented via an electronic medical record to improve patients' medication knowledge, adherence, and glycemic control compared to usual care. Design. A multicenter, randomized controlled trial in outpatient primary care clinics. 674 patients received either the Medtable tool or usual care and were followed up for up to 12 months. Results. Patients who received Medtable had greater knowledge about indications for medications in their regimens and were more satisfied with the information about their medications. Patients' knowledge of drug indication improved with Medtable regardless of their literacy status. However, Medtable did not improve patients' demonstrated medication use, regimen adherence, or glycemic control (HbA1c). Conclusion. The Medtable tool supported provider/patient collaboration related to medication use, as reflected in patient satisfaction with communication, but had limited impact on patient medication knowledge, adherence, and HbA1c outcomes. This trial is registered with ClinicalTrials.gov NCT01296633.

Figures

Figure 1
Figure 1
Example of Medtable. The patient and provider collaborate to choose times for each medication in the regimen. Modified and reprinted from [27] with permission from Elsevier.
Figure 2
Figure 2
Trial flow diagram.
Figure 3
Figure 3
Medication adherence and glycosylated hemoglobin (HbA1c) before and after intervention: Medtable versus usual care.

References

    1. American Diabetes Association. Standards of medical care in diabetes—2009. Diabetes Care. 2009;32(supplement 1):S13–S61. doi: 10.2337/dc09-s013.
    1. Aspden P., Wolcott J., Bootman J. L., Croenwett L. R. Preventing Medication Errors. Washington, DC, USA: The National Academies Press; 2007.
    1. Osterberg L., Blaschke T. Adherence to medication. The New England Journal of Medicine. 2005;353(5):487–497. doi: 10.1056/nejmra050100.
    1. Paasche-Orlow M. K., Schillinger D., Greene S. M., Wagner E. H. How health care systems can begin to address the challenge of limited literacy. Journal of General Internal Medicine. 2006;21(8):884–887. doi: 10.1111/j.1525-1497.2006.00544.x.
    1. Wolf M. S., Curtis L. M., Waite K., et al. Helping patients simplify and safely use complex prescription regimens. Archives of Internal Medicine. 2011;171(4):300–305. doi: 10.1001/archinternmed.2011.39.
    1. DeWalt D. A., Malone R. M., Bryant M. E., et al. A heart failure self-management program for patients of all literacy levels: a randomized, controlled trial [ISRCTN11535170] BMC Health Services Research. 2006;6, article 30 doi: 10.1186/1472-6963-6-30.
    1. Wolf M. S., Wilson E. A. H., Rapp D. N., et al. Literacy and learning in health care. Pediatrics. 2009;124(3):S275–S281. doi: 10.1542/peds.2009-1162C.
    1. Chin J., Morrow D. G., Stine-Morrow E. A. L., Conner-Garcia T., Graumlich J. F., Murray M. D. The process-knowledge model of health literacy: evidence from a componential analysis of two commonly used measures. Journal of Health Communication. 2011;16(3):222–241. doi: 10.1080/10810730.2011.604702.
    1. Park D. C., Jones T. R. Medication adherence and aging. In: Fisk A. D., Rogers W. A., editors. Handbook of Human Factors and the Older Adult. San Diego, Calif, USA: Academic Press; 1997. pp. 257–288.
    1. Bodenheimer T., Lorig K., Holman H., Grumbach K. Patient self-management of chronic disease in primary care. The Journal of the American Medical Association. 2002;288(19):2469–2475. doi: 10.1001/jama.288.19.2469.
    1. Wagner E. H., Bennett S. M., Austin B. T., Greene S. M., Schaefer J. K., Vonkorff M. Finding common ground: patient-centeredness and evidence-based chronic illness care. Journal of Alternative and Complementary Medicine. 2005;11(supplement 1):S7–S15. doi: 10.1089/acm.2005.11.7.
    1. Clark H. H. Using Language. Cambridge, UK: Cambridge University Press; 1996.
    1. Gerwing J., Indseth T., Gulbrandsen P. A microanalysis of the clarity of information in physicians' and patients' discussions of treatment plans with and without language barriers. Patient Education and Counseling. 2016;99(4):522–529. doi: 10.1016/j.pec.2015.10.012.
    1. Tarn D. M., Heritage J., Paterniti D. A., Hays R. D., Kravitz R. L., Wenger N. S. Physician communication when prescribing new medications. Archives of Internal Medicine. 2006;166(17):1855–1862. doi: 10.1001/archinte.166.17.1855.
    1. Stewart M. A. Effective physician-patient communication and health outcomes: a review. Canadian Medical Association Journal. 1995;152(9):1423–1433.
    1. Schillinger D., Piette J., Grumbach K., et al. Closing the loop: physician communication with diabetic patients who have low health literacy. Archives of Internal Medicine. 2003;163(1):83–90. doi: 10.1001/archinte.163.1.83.
    1. Tarn D. M., Paterniti D. A., Kravitz R. L., Fein S., Wenger N. S. How do physicians conduct medication reviews? Journal of General Internal Medicine. 2009;24(12):1296–1302. doi: 10.1007/s11606-009-1132-4.
    1. Skinner T. C., Barnard K., Cradock S., Parkin T. Patient and professional accuracy of recalled treatment decisions in out-patient consultations. Diabetic Medicine. 2007;24(5):557–560. doi: 10.1111/j.1464-5491.2007.02129.x.
    1. Schillinger D., Wang F., Rodriguez M., Bindman A., Machtinger E. L. The importance of establishing regimen concordance in preventing medication errors in anticoagulant care. Journal of Health Communication. 2006;11(6):555–567. doi: 10.1080/10810730600829874.
    1. Heisler M., Vijan S., Anderson R. M., Ubel P. A., Bernstein S. J., Hofer T. P. When do patients and their physicians agree on diabetes treatment goals and strategies, and what difference does it make? Journal of General Internal Medicine. 2003;18(11):893–902. doi: 10.1046/j.1525-1497.2003.21132.x.
    1. Schillinger D., Grumbach K., Piette J., et al. Association of health literacy with diabetes outcomes. The Journal of the American Medical Association. 2002;288(4):475–482. doi: 10.1001/jama.288.4.475.
    1. Persell S. D., Osborn C. Y., Richard R., Skripkauskas S., Wolf M. S. Limited health literacy is a barrier to medication reconciliation in ambulatory care. Journal of General Internal Medicine. 2007;22(11):1523–1526. doi: 10.1007/s11606-007-0334-x.
    1. Johnson A., Sandford J., Tyndall J. Written and verbal information versus verbal information only for patients being discharged from acute hospital settings to home. Cochrane Database of Systematic Reviews. 2003;4(4) doi: 10.1002/14651858.CD003716.CD003716
    1. Kripalani S., Robertson R., Love-Ghaffari M. H., et al. Development of an illustrated medication schedule as a low-literacy patient education tool. Patient Education and Counseling. 2007;66(3):368–377. doi: 10.1016/j.pec.2007.01.020.
    1. Cordasco K. M., Asch S. M., Bell D. S., et al. A low-literacy medication education tool for safety-net hospital patients. American Journal of Preventive Medicine. 2009;37(6):S209–S216. doi: 10.1016/j.amepre.2009.08.018.
    1. Machtinger E. L., Wang F., Chen L.-L., Rodriguez M., Wu S., Schillinger D. A visual medication schedule to improve anticoagulation control: a randomized, controlled trial. The Joint Commission Journal on Quality and Patient Safety. 2007;33(10):625–635.
    1. Morrow D. G., Conner-Garcia T., Graumlich J. F., et al. An EMR-based tool to support collaborative planning for medication use among adults with diabetes: design of a multi-site randomized control trial. Contemporary Clinical Trials. 2012;33(5):1023–1032. doi: 10.1016/j.cct.2012.05.010.
    1. Hazlehurst B., Gorman P. N., McMullen C. K. Distributed cognition: an alternative model of cognition for medical informatics. International Journal of Medical Informatics. 2008;77(4):226–234. doi: 10.1016/j.ijmedinf.2007.04.008.
    1. Sapkota S., Brien J.-A. E., Greenfield J. R., Aslani P. A systematic review of interventions addressing adherence to anti-diabetic medications in patients with type 2 diabetes—components of interventions. PLoS ONE. 2015;10(6) doi: 10.1371/journal.pone.0128626.e0128581
    1. Varming A. R., Hansen U. M., Andrésdóttir G., Husted G. R., Willaing I. Empowerment, motivation, and medical adherence (EMMA): the feasibility of a program for patient-centered consultations to support medication adherence and blood glucose control in adults with type 2 diabetes. Patient Preference and Adherence. 2015;9:1243–1253. doi: 10.2147/ppa.s85528.
    1. Heisler M., Choi H., Palmisano G., et al. Comparison of community health worker-led diabetes medication decision-making support for low-income latino and african american adults with diabetes using E-health tools versus print materials. Annals of Internal Medicine. 2014;161(10, supplement):S13–S22. doi: 10.7326/m13-3012.
    1. Farmer A., Hardeman W., Hughes D., et al. An explanatory randomised controlled trial of a nurse-led, consultation-based intervention to support patients with adherence to taking glucose lowering medication for type 2 diabetes. BMC Family Practice. 2012;13, article 30 doi: 10.1186/1471-2296-13-30.
    1. O'Connor P. J., Schmittdiel J. A., Pathak R. D., et al. Randomized trial of telephone outreach to improve medication adherence and metabolic control in adults with diabetes. Diabetes Care. 2014;37(12):3317–3324. doi: 10.2337/dc14-0596.
    1. Callahan C. M., Unverzagt F. W., Hui S. L., Perkins A. J., Hendrie H. C. Six-item screener to identify cognitive impairment among potential subjects for clinical research. Medical Care. 2002;40(9):771–781. doi: 10.1097/00005650-200209000-00007.
    1. Davis T. C., Federman A. D., Bass P. F., III, et al. Improving patient understanding of prescription drug label instructions. Journal of General Internal Medicine. 2009;24(1):57–62. doi: 10.1007/s11606-008-0833-4.
    1. Persell S. D., Heiman H. L., Weingart S. N., et al. Understanding of drug indications by ambulatory care patients. American Journal of Health-System Pharmacy. 2004;61(23):2523–2527.
    1. Wolf M. S., Davis T. C., Osborn C. Y., Skripkauskas S., Bennett C. L., Makoul G. Literacy, self-efficacy, and HIV medication adherence. Patient Education and Counseling. 2007;65(2):253–260. doi: 10.1016/j.pec.2006.08.006.
    1. Horne R., Hankins M., Jenkins R. The Satisfaction with Information about Medicines Scale (SIMS): a new measurement tool for audit and research. Quality in Health Care. 2001;10(3):135–140. doi: 10.1136/qhc.0100135...
    1. Davis T. C., Long S. W., Jackson R. H., et al. Rapid estimate of adult literacy in medicine: a shortened screening instrument. Family Medicine. 1993;25(6):391–395.
    1. Paasche-Orlow M. K., Parker R. M., Gazmararian J. A., Nielsen-Bohlman L. T., Rudd R. R. The prevalence of limited health literacy. Journal of General Internal Medicine. 2005;20(2):175–184. doi: 10.1111/j.1525-1497.2005.40245.x.
    1. Levinthal B. R., Morrow D. G., Tu W., Wu J., Murray M. D. Cognition and health literacy in patients with hypertension. Journal of General Internal Medicine. 2008;23(8):1172–1176. doi: 10.1007/s11606-008-0612-2.
    1. Salthouse T. A. Mediation of adult age differences in cognition by reductions in working memory and speed of processing. Psychological Science. 1991;2(3):179–183. doi: 10.1111/j.1467-9280.1991.tb00127.x.
    1. Garcia A. A., Villagomez E. T., Brown S. A., Kouzekanani K., Hanis C. L. The Starr County Diabetes Education Study: development of the Spanish-language diabetes knowledge questionnaire. Diabetes Care. 2001;24(1):16–21. doi: 10.2337/diacare.24.1.16.
    1. Toobert D. J., Hampson S. E., Glasgow R. E. The summary of diabetes self-care activities measure: results from 7 studies and a revised scale. Diabetes Care. 2000;23(7):943–950. doi: 10.2337/diacare.23.7.943.
    1. Charlson M. E., Pompei P., Ales K. L., MacKenzie C. R. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of Chronic Diseases. 1987;40(5):373–383. doi: 10.1016/0021-9681(87)90171-8.
    1. Ware J. E., Jr., Sherbourne C. D. The MOS 36-item short-form health survey (Sf-36). I. conceptual framework and item selection. Medical Care. 1992;30(6):473–483. doi: 10.1097/00005650-199206000-00002.
    1. George J., Phun Y.-T., Bailey M. J., Kong D. C. M., Stewart K. Development and validation of the medication regimen complexity index. The Annals of Pharmacotherapy. 2004;38(9):1369–1376. doi: 10.1345/aph.1d479.
    1. Fillenbaum G. Multidimensional Functional Assessment of Older Adults. Hillsdale, NJ, USA: Erlbaum; 1988.
    1. U.S. Food and Drug Administration—Center for Drug Evaluation and Research. Guidance for Industry, Diabetes Mellitus: Developing Drugs and Therapeutic Biologics for Treatment and Prevention. 2008. .
    1. Press I., Fullam F. Patient satisfaction in pay for performance programs. Quality Management in Health Care. 2011;20(2):110–115. doi: 10.1097/QMH.0b013e318213aed0.
    1. The Shaller Consulting Group and Robert Wood Johnson Foundation. Forces Driving Implementation of the CAHPS Clinician & Group Survey. March 2013, .
    1. Nieuwenhuis M. M., Jaarsma T., van Veldhuisen D. J., van der Wal M. H. Self-reported versus ‘true’ adherence in heart failure patients: a study using the Medication Event Monitoring System. Netherlands Heart Journal. 2012;20(7-8):313–319. doi: 10.1007/s12471-012-0283-9.
    1. Balkau B., Calvi-Gries F., Freemantle N., Vincent M., Pilorget V., Home P. D. Predictors of HbA1c over 4 years in people with type 2 diabetes starting insulin therapies: the CREDIT study. Diabetes Research and Clinical Practice. 2015;108(3):432–440. doi: 10.1016/j.diabres.2015.02.034.
    1. Schoenthaler A., Kalet A., Nicholson J., Lipkin M. Does improving patient-practitioner communication improve clinical outcomes in patients with cardiovascular diseases? A systematic review of the evidence. Patient Education and Counseling. 2014;96(1):3–12. doi: 10.1016/j.pec.2014.04.006.

Source: PubMed

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