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Published in: Trials 1/2015

Open Access 01-12-2015 | Study protocol

A primary care, electronic health record-based strategy to promote safe drug use: study protocol for a randomized controlled trial

Authors: Kamila Przytula, Stacy Cooper Bailey, William L Galanter, Bruce L Lambert, Neeha Shrestha, Carolyn Dickens, Suzanne Falck, Michael S Wolf

Published in: Trials | Issue 1/2015

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Abstract

Background

The Northwestern University Center for Education and Research on Therapeutics (CERT), funded by the Agency for Healthcare Research and Quality, is one of seven such centers in the USA. The thematic focus of the Northwestern CERT is ‘Tools for Optimizing Medication Safety.’ Ensuring drug safety is essential, as many adults struggle to take medications, with estimates indicating that only half of adults take drugs as prescribed. This report describes the methods and rationale for one innovative project within the CERT: the ‘Primary Care, Electronic Health Record-Based Strategy to Promote Safe and Appropriate Drug Use’.

Methods/Design

The overall objective of this 5-year study is to evaluate a health literacy-informed, electronic health record-based strategy for promoting safe and effective prescription medication use in a primary care setting. A total of 600 English and Spanish-speaking patients with diabetes will be consecutively recruited to participate in the study. Patients will be randomized to receive either usual care or the intervention; those in the intervention arm will receive a set of print materials designed to support medication use and prompt provider counseling and medication reconciliation. Participants will be interviewed in person after their index clinic visit and again one month later. Process outcomes related to intervention delivery will be recorded. A medical chart review will be performed at 6 months. Patient outcome measures include medication understanding, adherence and clinical measures (hemoglobin A1c, blood pressure, and cholesterol; exploratory outcomes only).

Discussion

Through this study, we will be able to examine the impact of a health literacy-informed, electronic health record-based strategy on medication understanding and adherence among diabetic primary care patients. The measurement of process outcomes will help inform how the strategy might ultimately be refined and disseminated to other sites. Strategies such as these are needed to address the multifaceted challenges related to medication self-management among patients with chronic conditions.

Trial registration

Clinicaltrials.gov NCT01669473.
Literature
1.
go back to reference Institute of Medicine. Health Literacy: A Prescription to End Confusion. Washington DC: National Academy Press; 2004. Institute of Medicine. Health Literacy: A Prescription to End Confusion. Washington DC: National Academy Press; 2004.
2.
go back to reference Gu Q, Dillon CF, Burt VL. Prescription Drug Use Continues to Increase: U.S. Prescription Drug Data for 2007–2008. NCHS Data Brief. 2010;42:1–8. Gu Q, Dillon CF, Burt VL. Prescription Drug Use Continues to Increase: U.S. Prescription Drug Data for 2007–2008. NCHS Data Brief. 2010;42:1–8.
3.
go back to reference Haynes RB, Yao X, Degani A, Kripalani S, Garg A, McDonald HP. Interventions for enhancing medication adherence. Cochrane Database Syst Rev. 2005;4:CD000011. Haynes RB, Yao X, Degani A, Kripalani S, Garg A, McDonald HP. Interventions for enhancing medication adherence. Cochrane Database Syst Rev. 2005;4:CD000011.
4.
go back to reference Wilson E, Chen AH, Grumbach K, Wang F, Fernandez A. Effects of limited English proficiency and physician language on health care comprehension. J Gen Intern Med. 2005;20(9):800–6.CrossRefPubMedPubMedCentral Wilson E, Chen AH, Grumbach K, Wang F, Fernandez A. Effects of limited English proficiency and physician language on health care comprehension. J Gen Intern Med. 2005;20(9):800–6.CrossRefPubMedPubMedCentral
5.
go back to reference Wolf MS, Curtis LM, Waite K, Bailey SC, Hedlund LA, Davis TC, et al. Helping patients simplify and safely use complex prescription regimens. Arch Intern Med. 2011;171(4):300–5.CrossRefPubMedPubMedCentral Wolf MS, Curtis LM, Waite K, Bailey SC, Hedlund LA, Davis TC, et al. Helping patients simplify and safely use complex prescription regimens. Arch Intern Med. 2011;171(4):300–5.CrossRefPubMedPubMedCentral
6.
go back to reference Wolf MS, Davis TC, Tilson HH, Bass 3rd PF, Parker RM. Misunderstanding of prescription drug warning labels among patients with low literacy. Am J Health Syst Pharm. 2006;63(11):1048–55.CrossRefPubMed Wolf MS, Davis TC, Tilson HH, Bass 3rd PF, Parker RM. Misunderstanding of prescription drug warning labels among patients with low literacy. Am J Health Syst Pharm. 2006;63(11):1048–55.CrossRefPubMed
7.
go back to reference Callahan CM, Unverzagt FW, Hui SL, Perkins AJ, Hendrie HC. Six-item screener to identify cognitive impairment among potential subjects for clinical research. Med Care. 2002;40(9):771–81.CrossRefPubMed Callahan CM, Unverzagt FW, Hui SL, Perkins AJ, Hendrie HC. Six-item screener to identify cognitive impairment among potential subjects for clinical research. Med Care. 2002;40(9):771–81.CrossRefPubMed
8.
go back to reference Doak CC, Doak LG, Root JH. Assessing Suitability of Materials. Teaching Patients with Low Literacy Skills. 2nd ed. Philadelphia: JB Lippincott; 1996. Doak CC, Doak LG, Root JH. Assessing Suitability of Materials. Teaching Patients with Low Literacy Skills. 2nd ed. Philadelphia: JB Lippincott; 1996.
9.
go back to reference Doak LG, Doak CC, Meade CD. Strategies to improve cancer education materials. Oncol Nurs Forum. 1996;23(8):1305–12.PubMed Doak LG, Doak CC, Meade CD. Strategies to improve cancer education materials. Oncol Nurs Forum. 1996;23(8):1305–12.PubMed
10.
go back to reference Harkness J, Pennell BE, Schoua-Glusberg A: Survey questionnaire translation and assessment. In Methods for Testing and Evaluating Survey Questionnaires. Edited by Presser S, Rothgeb JM, Couper MP, Lessler JT, Martin E, Martin J, Singer E. Hoboken, NJ: John Wiley & Sons; 2004:453–473. Harkness J, Pennell BE, Schoua-Glusberg A: Survey questionnaire translation and assessment. In Methods for Testing and Evaluating Survey Questionnaires. Edited by Presser S, Rothgeb JM, Couper MP, Lessler JT, Martin E, Martin J, Singer E. Hoboken, NJ: John Wiley & Sons; 2004:453–473.
11.
go back to reference Leyva M, Sharif I, Ozuah PO. Health literacy among Spanish-speaking Latino parents with limited English proficiency. Ambul Pediatr. 2005;5(1):56–9.CrossRefPubMed Leyva M, Sharif I, Ozuah PO. Health literacy among Spanish-speaking Latino parents with limited English proficiency. Ambul Pediatr. 2005;5(1):56–9.CrossRefPubMed
12.
go back to reference Blumenthal D, Tavenner M. The ‘meaningful use’ regulation for electronic health records. N Engl J Med. 2010;363(6):501–4.CrossRefPubMed Blumenthal D, Tavenner M. The ‘meaningful use’ regulation for electronic health records. N Engl J Med. 2010;363(6):501–4.CrossRefPubMed
13.
go back to reference Bayoumi I, Howard M, Holbrook AM, Schabort I. Interventions to improve medication reconciliation in primary care. Ann Pharmacother. 2009;43(10):1667–75.CrossRefPubMed Bayoumi I, Howard M, Holbrook AM, Schabort I. Interventions to improve medication reconciliation in primary care. Ann Pharmacother. 2009;43(10):1667–75.CrossRefPubMed
14.
go back to reference Persell SD, Osborn CY, Richard R, Skripkauskas S, Wolf MS. Limited health literacy is a barrier to medication reconciliation in ambulatory care. J Gen Intern Med. 2007;22(11):1523–6.CrossRefPubMedPubMedCentral Persell SD, Osborn CY, Richard R, Skripkauskas S, Wolf MS. Limited health literacy is a barrier to medication reconciliation in ambulatory care. J Gen Intern Med. 2007;22(11):1523–6.CrossRefPubMedPubMedCentral
15.
go back to reference Persell SD, Bailey SC, Tang J, Davis TC, Wolf MS. Medication reconciliation and hypertension control. Am J Med. 2010;123(2):182 e189–15.CrossRef Persell SD, Bailey SC, Tang J, Davis TC, Wolf MS. Medication reconciliation and hypertension control. Am J Med. 2010;123(2):182 e189–15.CrossRef
16.
go back to reference Webb JR, Feinglass J, Makoul G, Wilkes CL, Dunham DP, Baker DW, et al. Can electronic health records help improve patients’ understanding of medications? Am J Manag Care. 2010;16(12):919–22.PubMedPubMedCentral Webb JR, Feinglass J, Makoul G, Wilkes CL, Dunham DP, Baker DW, et al. Can electronic health records help improve patients’ understanding of medications? Am J Manag Care. 2010;16(12):919–22.PubMedPubMedCentral
17.
go back to reference Bailey SC, Sarkar U, Chen AH, Schillinger D, Wolf MS. Evaluation of language concordant, patient-centered drug label instructions. J Gen Intern Med. 2012;27(12):1707–13.CrossRefPubMedPubMedCentral Bailey SC, Sarkar U, Chen AH, Schillinger D, Wolf MS. Evaluation of language concordant, patient-centered drug label instructions. J Gen Intern Med. 2012;27(12):1707–13.CrossRefPubMedPubMedCentral
18.
go back to reference Morrow DG, Conner-Garcia T, Graumlich JF, Wolf MS, McKeever S, Madison A, 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. Contemp Clin Trials. 2012;33(5):1023–32.CrossRefPubMedPubMedCentral Morrow DG, Conner-Garcia T, Graumlich JF, Wolf MS, McKeever S, Madison A, 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. Contemp Clin Trials. 2012;33(5):1023–32.CrossRefPubMedPubMedCentral
19.
go back to reference Saini SD, Schoenfeld P, Kaulback K, Dubinsky MC. Effect of medication dosing frequency on adherence in chronic diseases. Am J Manag Care. 2009;15(6):e22–33.PubMed Saini SD, Schoenfeld P, Kaulback K, Dubinsky MC. Effect of medication dosing frequency on adherence in chronic diseases. Am J Manag Care. 2009;15(6):e22–33.PubMed
20.
go back to reference Vermeire E, Hearnshaw H, Van Royen P, Denekens J. Patient adherence to treatment: three decades of research. A comprehensive review. J Clin Pharm Ther. 2001;26(5):331–42.CrossRefPubMed Vermeire E, Hearnshaw H, Van Royen P, Denekens J. Patient adherence to treatment: three decades of research. A comprehensive review. J Clin Pharm Ther. 2001;26(5):331–42.CrossRefPubMed
21.
go back to reference Gazmararian JA, Kripalani S, Miller MJ, Echt KV, Ren J, Rask K. Factors associated with medication refill adherence in cardiovascular-related diseases: a focus on health literacy. J Gen Intern Med. 2006;21(12):1215–21.CrossRefPubMedPubMedCentral Gazmararian JA, Kripalani S, Miller MJ, Echt KV, Ren J, Rask K. Factors associated with medication refill adherence in cardiovascular-related diseases: a focus on health literacy. J Gen Intern Med. 2006;21(12):1215–21.CrossRefPubMedPubMedCentral
22.
go back to reference Benner JS, Glynn RJ, Mogun H, Neumann PJ, Weinstein MC, Avorn J. Long-term persistence in use of statin therapy in elderly patients. JAMA. 2002;288(4):455–61.CrossRefPubMed Benner JS, Glynn RJ, Mogun H, Neumann PJ, Weinstein MC, Avorn J. Long-term persistence in use of statin therapy in elderly patients. JAMA. 2002;288(4):455–61.CrossRefPubMed
24.
go back to reference Cramer JA. A systematic review of adherence with medications for diabetes. Diabetes Care. 2004;27(5):1218–24.CrossRefPubMed Cramer JA. A systematic review of adherence with medications for diabetes. Diabetes Care. 2004;27(5):1218–24.CrossRefPubMed
25.
go back to reference Io M. Methodological Challenges in Biomedical HIV Prevention Trials. Washington, DC: National Academies Press; 2008. Io M. Methodological Challenges in Biomedical HIV Prevention Trials. Washington, DC: National Academies Press; 2008.
26.
go back to reference Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24(1):67–74.CrossRefPubMed Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24(1):67–74.CrossRefPubMed
27.
go back to reference Weiss BD, Mays MZ, Martz W, Castro KM, DeWalt DA, Pignone MP, et al. Quick assessment of literacy in primary care: the Newest Vital Sign. Ann Fam Med. 2005;3:514–22.CrossRefPubMedPubMedCentral Weiss BD, Mays MZ, Martz W, Castro KM, DeWalt DA, Pignone MP, et al. Quick assessment of literacy in primary care: the Newest Vital Sign. Ann Fam Med. 2005;3:514–22.CrossRefPubMedPubMedCentral
28.
go back to reference Davis TC, Federman AD, Bass 3rd PF, Jackson RH, Middlebrooks M, Parker RM, et al. Improving patient understanding of prescription drug instructions. J Gen Intern Med. 2009;24:57–62.CrossRefPubMed Davis TC, Federman AD, Bass 3rd PF, Jackson RH, Middlebrooks M, Parker RM, et al. Improving patient understanding of prescription drug instructions. J Gen Intern Med. 2009;24:57–62.CrossRefPubMed
29.
go back to reference Davis TC, Wolf MS, Bass 3rd PF, Thompson JA, Tilson HH, Neuberger M, et al. Literacy and misunderstanding prescription drug labels. Ann Intern Med. 2006;145(12):887–94.CrossRefPubMed Davis TC, Wolf MS, Bass 3rd PF, Thompson JA, Tilson HH, Neuberger M, et al. Literacy and misunderstanding prescription drug labels. Ann Intern Med. 2006;145(12):887–94.CrossRefPubMed
32.
go back to reference Jamoom E, Beatty P, Bercovitz A, Woodwell D, Palso K, Rechtsteiner E. Physician adoption of electronic health record systems: United States, 2011. NCHS Data Brief. 2012;98:1–8. Jamoom E, Beatty P, Bercovitz A, Woodwell D, Palso K, Rechtsteiner E. Physician adoption of electronic health record systems: United States, 2011. NCHS Data Brief. 2012;98:1–8.
33.
go back to reference Bosworth HB, Granger BB, Mendys P, Brindis R, Burkholder R, Czajkowski SM, et al. Medication adherence: a call for action. Am Heart J Sep. 2011;162(3):412–24.CrossRef Bosworth HB, Granger BB, Mendys P, Brindis R, Burkholder R, Czajkowski SM, et al. Medication adherence: a call for action. Am Heart J Sep. 2011;162(3):412–24.CrossRef
Metadata
Title
A primary care, electronic health record-based strategy to promote safe drug use: study protocol for a randomized controlled trial
Authors
Kamila Przytula
Stacy Cooper Bailey
William L Galanter
Bruce L Lambert
Neeha Shrestha
Carolyn Dickens
Suzanne Falck
Michael S Wolf
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Trials / Issue 1/2015
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/s13063-014-0524-x

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