BACKGROUND:

Failure of older adults to take medications properly is estimated to be a factor in more than a quarter of emergency room visits and 10% of nursing home admissions with a total cost of over $25 billion annually (Gurwitz et al., 2003; Salzman, 1995; Tafreshi, Melby, Kaback & Nord, 1999; Task Force for Compliance, 1994). It has been estimated that 10% of adverse drug events may be attributed to communication failure between the provider and patient (IOM, 2000). Lack of adherence to prescription medication protocols and adverse self-medication practices can result in drug interactions that can be fatal. In a health environment that promotes polypharmacy for older adults, a group that is less well able to see, hear, and understand medical information than the general population, a need exists to educate both older adults and their providers about the dangers of adverse drug interactions arising from self-medication.

DESIGN NARRATIVE:

The goal is to reduce adverse self-medication practices in older adults with hypertension. A computer program developed for older adults (Personal Education Program or PEP) will be modified as the next generation PEP, or PEP-NG, to include an interface to allow clients to enter self-medication behavior data independently on a wireless, touch screen tablet PC. Data entered on the PEP-NG will be analyzed via a secure server (ProHealth) and program content tailored to the specific adverse self-medication behaviors will be delivered. Summaries of the reported behaviors with corrective strategies will be printed for both patient and provider so the APRN has a good idea of the client''''s self-medication practices before beginning the face-to-face interview. Thus, the PEP-NG will make optimal use of the client''''s waiting time and the APRN''''s clinical time.

Specific aims are at three levels. 1) To design an interface for the PEP-NG with: a) desirable characteristics for both older adults and primary care providers; and b) minimal user burden. 2) To show that APRNs will increase: a) knowledge concerning potential drug interactions arising from older adults'''' self-medication practices; b) self-efficacy for teaching older adults about potential drug interactions; c) self-efficacy for communicating with older adults about self-medication; and to c) demonstrate satisfaction using the PEP-NG with clients. 3) To show that older adults using the PEP-NG will: a) increase knowledge concerning potential drug interactions arising from self-medication practices; b) increase self-efficacy as to how to avoid potential drug interactions arising from self-medication practice; c) reduce self-reported adverse behaviors associated with potential drug interactions; 4) improve prescription medication adherence; d) achieve target blood pressure readings; and demonstrate e) satisfaction with the PEP-NG and f) the APRN provider relationship. User-sensitive inclusive design methods will be used to develop and test the patient data interface. After beta-testing the PEP-NG in the primary care laboratory, the PEP-NG will be piloted by 20 APRNs affiliated with ProHealth primary care practices. RMANOVA with one within subjects factor (TIME) will be performed on APRNs'''' outcome measures at time 0, immediate post-instruction, and 3 and 6 months later. APRNs will each recruit 25 clients (500 total) meeting study criteria. The PEP-NG software will randomly assign each APRN''''s clients to either control (data collection only) and experimental (data collection plus educational intervention with targeted messages). Client outcome will be assessed at 0, 4, 8, 12, and 52 weeks and analyzed as a mixed ANOVA with NURSE and GROUP as between-subjects factors and TIME as a repeated-measures factor. Healthcare utilization will be compared between the 2 groups after 52 weeks and a cost-benefit analysis conducted.