Northwestern University and Access Community Health Network Medication Education Study
| Status: | Completed |
|---|---|
| Conditions: | High Blood Pressure (Hypertension) |
| Therapuetic Areas: | Cardiology / Vascular Diseases |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 3/16/2015 |
| Start Date: | April 2012 |
| End Date: | April 2016 |
| Contact: | Elisha Friesema, BA, CCRP |
| Email: | e-friesema@northwestern.edu |
| Phone: | 312-503-2753 |
EHR-based Health Literacy Strategy to Promote Medication Therapy Management
Many patients have difficulty performing routine medication management tasks. Individuals
with limited literacy are at high risk for these problems. The overall study objective is to
rigorously evaluate two primary care-based medication therapy management strategies that
leverage an electronic health record (EHR) to promote patient understanding, medication
reconciliation, medication adherence and disease control among hypertensive patients at
safety net clinics.
with limited literacy are at high risk for these problems. The overall study objective is to
rigorously evaluate two primary care-based medication therapy management strategies that
leverage an electronic health record (EHR) to promote patient understanding, medication
reconciliation, medication adherence and disease control among hypertensive patients at
safety net clinics.
Medication therapy management (MTM) has been described as a set of procedures that include:
medication review, assembly of a personal medication record, development of action plans,
intervention when necessary, and follow-up. However, evidence showing the effectiveness of
general MTM interventions is scant. MTM has often been performed separately from patients'
usual sources of care (i.e., at pharmacies). This could limit its effectiveness since
medication-related concerns would be discussed by clinicians who are not aware of the
regimen intended by patients' prescribers. Cost is another barrier to widespread use of MTM.
Health information technology in primary care could be leveraged to assist with MTM tasks.
The investigators have field tested low literacy MTM tools embedded within an EHR to 1)
activate patients to review medications, 2) automate the provision of plain language,
medication information, and 3) provide print tools to help patients engage providers, and
consolidate their regime. These tools were developed with patient, physician, and pharmacist
feedback.
For this study, the investigators combine tools to address the range of MTM tasks. In
aggregate, the study refers to this as an Electronic health record-based Health literacy
Medication therapy management Intervention, or 'EHMI'. The investigators will evaluate the
effects of this approach among patients with uncontrolled hypertension treated in federally
qualified health centers (FQHCs). This may be a relatively low-cost strategy ideal for
safety net practices that use EHRs and whose patients may be at greater risk for limited
literacy. It is also possible that the EHMI strategy may not result in a significant change.
Therefore, the investigators will also evaluate using a nurse educator to help patients
utilize EHMI tools, provide brief counseling, and track progress.
This three-arm, clinic-randomized, controlled trial conducted within a network of FQHCs will
evaluate the EHMI and EHMI + Nurse Educator interventions compared to usual care. Recruited
patients will be followed for 12 months. The investigators will test the impact of these two
strategies on blood pressure levels, with an anticipated power to detect a 4 mm Hg
difference in systolic blood pressure as the primary outcome. The investigators will also
assess the impact on diastolic blood pressure, as well as HbA1c and LDL cholesterol control
in the subgroup with diabetes. The investigators will determine the interventions' effects
on: 1) medication understanding, 2) discrepancies, and 3) adherence. The investigators will
specifically examine intervention effects among groups with different literacy levels. The
investigators will also assess the fidelity and cost of the interventions to guide future
dissemination efforts.
medication review, assembly of a personal medication record, development of action plans,
intervention when necessary, and follow-up. However, evidence showing the effectiveness of
general MTM interventions is scant. MTM has often been performed separately from patients'
usual sources of care (i.e., at pharmacies). This could limit its effectiveness since
medication-related concerns would be discussed by clinicians who are not aware of the
regimen intended by patients' prescribers. Cost is another barrier to widespread use of MTM.
Health information technology in primary care could be leveraged to assist with MTM tasks.
The investigators have field tested low literacy MTM tools embedded within an EHR to 1)
activate patients to review medications, 2) automate the provision of plain language,
medication information, and 3) provide print tools to help patients engage providers, and
consolidate their regime. These tools were developed with patient, physician, and pharmacist
feedback.
For this study, the investigators combine tools to address the range of MTM tasks. In
aggregate, the study refers to this as an Electronic health record-based Health literacy
Medication therapy management Intervention, or 'EHMI'. The investigators will evaluate the
effects of this approach among patients with uncontrolled hypertension treated in federally
qualified health centers (FQHCs). This may be a relatively low-cost strategy ideal for
safety net practices that use EHRs and whose patients may be at greater risk for limited
literacy. It is also possible that the EHMI strategy may not result in a significant change.
Therefore, the investigators will also evaluate using a nurse educator to help patients
utilize EHMI tools, provide brief counseling, and track progress.
This three-arm, clinic-randomized, controlled trial conducted within a network of FQHCs will
evaluate the EHMI and EHMI + Nurse Educator interventions compared to usual care. Recruited
patients will be followed for 12 months. The investigators will test the impact of these two
strategies on blood pressure levels, with an anticipated power to detect a 4 mm Hg
difference in systolic blood pressure as the primary outcome. The investigators will also
assess the impact on diastolic blood pressure, as well as HbA1c and LDL cholesterol control
in the subgroup with diabetes. The investigators will determine the interventions' effects
on: 1) medication understanding, 2) discrepancies, and 3) adherence. The investigators will
specifically examine intervention effects among groups with different literacy levels. The
investigators will also assess the fidelity and cost of the interventions to guide future
dissemination efforts.
Inclusion Criteria:
- age is 18 years or older
- at least 3 medications are prescribed by their physician
- standardized mean blood pressure measurement ≥130 mm Hg systolic or ≥ 80 mm Hg
diastolic if they are diabetic or mean blood pressure measurement ≥ 135 mm Hg
systolic or ≥ 85 mm Hg diastolic if they are not
- a Mini-Cog Exam score of ≥ 3
- the patient is the person primarily responsible for administering their medication
- the patient does not intend to move or change their usual source of medical care
during the next year.
Exclusion Criteria:
- the patient's usual source of medical care is not a participating ACCESS Community
Health Center
- is non-English language speaking
- does not meet mean blood pressure criteria
- has a Mini-Cog Exam score of < 3
- is not the person primarily responsible for administering medication
- intends to move or change their usual source of medical care during the next year.
- Is not prescribed at least 3 medications
We found this trial at
1
site
Click here to add this to my saved trials
