Personal Health Records and Elder Medication Use Quality

Personal health records (PHRs) are an opportunity to increase the involvement of patients in managing their own health. It is believed that increased access to health information through PHR use will increase patient activation and consequently improve patient health behaviors and ultimately health outcomes. There are many documented risks for older adults with their medications. Older adults are vulnerable to medication side effects because of multiple chronic conditions, increased exposure to numerous medications, and the effects of aging on medications’ pharmacokinetic and pharmacodynamic properties. These risks may be better managed by engaging patients in their own care via a PHR.

This research was a collaboration of the University of Iowa Older Adults Center for Education and Research on Therapeutics and the Iowa Research Network. The project conducted a randomized controlled trial among older adults of the effect of a current representative PHR system on patient-reported medication therapy management (MTM) behaviors, beliefs about medications, medication-use quality indicators, and on medication adherence. The specific aims of the project were to:

• Develop, through patient and provider focus groups, measures of patient MTM behaviors and patient self-efficacy for MTM
• Compare, in a trial in a primary care Practice-based Research Network, the 6- and 12-month patient-reported MTM behaviors, medication adherence, patient- and physician-centric medication quality indicators, patient self-efficacy for MTM, and patient beliefs about medication, among those randomized to a current, representative PHR system versus those randomized to usual care
• Investigate the usability of the PHR system in a human-computer interaction laboratory compared with alternative prototypes developed through participatory design with older adults of varying ability levels, and associate PHR performance with measures of cognitive, motor, and perceptual ability

Laboratory sessions compared the usability of a commercial PHR among older versus younger adults. Because all participants had difficulty in the laboratory tasks, especially managing medication information, the research team partnered with a group of adults age 65 and older in 13 sessions over 4 weeks to develop design guidelines for a new PHR. Prototypes of the PHR were tested in focus groups of older adults and the final version tested in a 6-month randomized controlled trial. After completing mailed baseline questionnaires, eligible computer users aged 65 and older were randomized to be given access to the PHR or serve as a standard care control group. Followup questionnaires measured change from baseline medication use, behaviors, quality, and adherence.

Older adults were interested in keeping track of their health and medication information. A majority, 55.2 percent, logged into the PHR and used it, but only 16.1 percent used it frequently. Compared with low/non-users, frequent users reported significantly improved medication management behaviors, reported better medication reconciliation by their providers, and recognized significantly more side effects. There was no difference in quality or adherence measures. PHRs can engage older adults, but features that reduce barriers and motivate continued use must be explored.