Expanding the Universal Medication Schedule: a patient-centred approach

Bailey, Stacy Cooper; Wolf, Michael S.; López, Andrea; Russell, Allison L.; Chen, Alice Hm; Schillinger, Dean; Moy, Glen; Sarkar, Urmimala

doi:10.1136/bmjopen-2013-003699

Cited by 29 publications

(32 citation statements)

References 22 publications

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“…This has served as a common outcome in prior studies. 2,4,[19][20][21][22][23] A regimen summary score at the patient level was also calculated, indicating whether the dosing of all medications a patient was taking was correct. The secondary outcome under study was adherence, measured via 1) self-report of missed or incorrect doses in the prior 4 days using the Patient Medication Adherence Questionnaire (PMAQ) 28,29 and 2) pill count (for diabetes and hypertensive medicines).…”

Section: Discussionmentioning

confidence: 99%

“…10,25 The acceptability of the labeling was also supported by patient focus groups. 21 Label changes included dose instructions that were written in UMS form, stating when to take a medication using one of four daily standard time intervals (morning, noon, evening, bedtime). A graphic aid was also placed in the center of the label, below the instructions, to visually display the dose (number of pills) per specified interval(s).…”

Section: Interventionmentioning

confidence: 99%

“…Btake 1 tablet twice daily^) were better able to demonstrate proper dosing and spacing of medication. [19][20][21][22] This has even led to a reduction in known disparities, as adults with low literacy benefited the most. These findings have since been replicated in one international study 23 and among LEP patients.…”

Section: Introductionmentioning

confidence: 99%

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A Patient-Centered Prescription Drug Label to Promote Appropriate Medication Use and Adherence

et al. 2016

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BACKGROUND: Patient misunderstanding of prescription drug label instructions is a common cause of unintentional misuse of medication and adverse health outcomes. Those with limited literacy and English proficiency are at greater risk. OBJECTIVE: To test the effectiveness of a patientcentered drug label strategy, including a Universal Medication Schedule (UMS), to improve proper regimen use and adherence compared to a current standard. DESIGN: Two-arm, multi-site patient-randomized pragmatic trial. PARTICIPANTS: English-and Spanish-speaking patients from eight community health centers in northern Virginia who received prescriptions from a central-fill pharmacy and who were 1) ≥30 years of age, 2) diagnosed with type 2 diabetes and/or hypertension, and 3) taking ≥2 oral medications. INTERVENTION: A patient-centered label (PCL) strategy that incorporated evidence-based practices for format and content, including prioritized information, larger font size, and increased white space. Most notably, instructions were conveyed with the UMS, which uses standard intervals for expressing when to take medicine (morning, noon, evening, bedtime). MAIN MEASURES: Demonstrated proper use of a multidrug regimen; medication adherence measured by selfreport and pill count at 3 and 9 months. KEY RESULTS: A total of 845 patients participated in the study (85.6 % cooperation rate). Patients receiving the PCL demonstrated slightly better proper use of their drug regimens at first exposure (76.9 % vs. 70.1 %, p = 0.06) and at 9 months (85.9 % vs. 77.4 %, p = 0.03). The effect of the PCL was significant for English-speaking patients (OR 2.21, 95 % CI 1.13-4.31) but not for Spanish speakers (OR 1.19, 95 % CI 0.63-2.24). Overall, the intervention did not improve medication adherence. However, significant benefits from the PCL were found among patients with limited literacy (OR 5.08,) and for those with medications to be taken ≥2 times a day (OR 2.77, 95 % CI 1.17-6.53). CONCLUSIONS:A simple modification to pharmacygenerated labeling, with minimal investment required, can offer modest improvements to regimen use and adherence, mostly among patients with limited literacy and more complex regimens. Trial Registration (ClinicalTrials.gov): NCT00973180, NCT01200849

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Section: Discussionmentioning

confidence: 99%

Section: Interventionmentioning

confidence: 99%

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A Patient-Centered Prescription Drug Label to Promote Appropriate Medication Use and Adherence

et al. 2016

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“…While we did not ask questions about income level, the patient population at this hospital is known to be low income. 35,36 All participants self-identified as having type 2 diabetes, having depressive symptoms, or being a caregiver for someone with a chronic condition in order to participate in the testing of the concordant category of apps. In addition to these conditions, we asked participants if they had asthma or chronic obstructive pulmonary disease (COPD), heart disease, high blood pressure, heart failure, and chronic kidney disease.…”

Section: Study Setting and Patientsmentioning

confidence: 99%

Usability of Commercially Available Mobile Applications for Diverse Patients

et al. 2016

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BACKGROUND:Mobile applications or 'apps' intended to help people manage their health and chronic conditions are widespread and gaining in popularity. However, little is known about their acceptability and usability for lowincome, racially/ethnically diverse populations who experience a disproportionate burden of chronic disease and its complications. OBJECTIVE: The objective of this study was to investigate the usability of existing mobile health applications ("apps") for diabetes, depression, and caregiving, in order to facilitate development and tailoring of patient-facing apps for diverse populations. DESIGN: Usability testing, a mixed-methods approach that includes interviewing and direct observation of participant technology use, was conducted with participants (n = 9 caregivers; n = 10 patients with depression; and n = 10 patients with diabetes) on a total of 11 of the most popular health apps (four diabetes apps, four depression apps, and three caregiver apps) on both iPad and Android tablets. PARTICIPANTS: The participants were diverse: 15 (58 %) African Americans, seven (27 %) Whites, two (8 %) Asians, two (8 %) Latinos with either diabetes, depression, or who were caregivers. MAIN MEASURES: Participants were given conditionspecific tasks, such as entering a blood glucose value into a diabetes app. Participant interviews were video recorded and were coded using standard methods to evaluate attempts and completions of tasks. We performed inductive coding of participant comments to identify emergent themes. KEY RESULTS: Participants completed 79 of 185 (43 %) tasks across 11 apps without assistance. Three themes emerged from participant comments: lack of confidence with technology, frustration with design features and navigation, and interest in having technology to support their self-management.CONCLUSIONS: App developers should employ participatory design strategies in order to have an impact on chronic conditions such as diabetes and depression that disproportionately affect vulnerable populations. While patients express interest in using technologies for selfmanagement, current tools are not consistently usable for diverse patients.

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“…The Take‐Wait‐Stop prescription wording translates medications prescribed “as needed” into plain language with three deconstructed, actionable steps(Figure ). The Take‐Wait‐Stop label was first developed by members of our team as an extension of the universal medication schedule and based on tenets of patient‐centered prescription label design . The prescription wording places emphasis on action terms (Take‐Wait‐Stop) and deconstructs the components of PRN instructions to support understanding and recall.…”

Section: Methodsmentioning

confidence: 99%

A Multifaceted Intervention to Improve Patient Knowledge and Safe Use of Opioids: Results of the ED EMC² Randomized Controlled Trial

McCarthy

Curtis

Courtney

et al. 2019

Academic Emergency Medicine

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Objectives: Despite increased focus on opioid prescribing, little is known about the influence of prescription opioid medication information given to patients in the emergency department (ED). The study objective was to evaluate the effect of an Electronic Medication Complete Communication (EMC 2 ) Opioid Strategy on patients' safe use of opioids and knowledge about opioids.Methods: This was a three-arm prospective, randomized controlled pragmatic trial with randomization occurring at the physician level. Consecutive discharged patients at an urban academic ED (>88,000 visits) with new hydrocodone-acetaminophen prescriptions received one of three care pathways: 1) usual care, 2) EMC 2 intervention, or 3) EMC 2 + short message service (SMS) text messaging. The ED EMC 2 intervention triggered two patient-facing educational tools (MedSheet, literacy-appropriate prescription wording [Take-Wait-Stop]) and three provider-facing reminders to counsel (directed to ED physician, dispensing pharmacist, follow-up physician). Patients in the EMC 2 + SMS arm additionally received one text message/day for 1 week. Follow-up at 1 to 2 weeks assessed "demonstrated safe use" (primary outcome). Secondary outcomes including patient knowledge and actual safe use (via medication diaries) were assessed 2 to 4 days and 1 month following enrollment.Results: Among the 652 enrolled, 343 completed follow-up (57% women; mean AE SD age = 42 AE 14.0 years).Demonstrated safe opioid use occurred more often in the EMC 2 group (adjusted odds ratio [aOR] = 2.46, 95% confidence interval [CI] = 1.19 to 5.06), but not the EMC 2 + SMS group (aOR = 1.87, 95% CI = 0.90 to 3.90) compared with usual care. Neither intervention arm improved medication safe use as measured by medication diary data. Medication knowledge, measured by a 10-point composite knowledge score, was greater in the EMC 2 + SMS group (b = 0.57, 95% CI = 0.09 to 1.06) than usual care. Conclusions:The study found that the EMC 2 tools improved demonstrated safe dosing, but these benefits did not translate into actual use based on medication dairies. The text-messaging intervention did result in improved patient knowledge.

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Expanding the Universal Medication Schedule: a patient-centred approach

Cited by 29 publications

References 22 publications

A Patient-Centered Prescription Drug Label to Promote Appropriate Medication Use and Adherence

A Patient-Centered Prescription Drug Label to Promote Appropriate Medication Use and Adherence

Usability of Commercially Available Mobile Applications for Diverse Patients

A Multifaceted Intervention to Improve Patient Knowledge and Safe Use of Opioids: Results of the ED EMC² Randomized Controlled Trial

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Expanding the Universal Medication Schedule: a patient-centred approach

Cited by 29 publications

References 22 publications

A Patient-Centered Prescription Drug Label to Promote Appropriate Medication Use and Adherence

A Patient-Centered Prescription Drug Label to Promote Appropriate Medication Use and Adherence

Usability of Commercially Available Mobile Applications for Diverse Patients

A Multifaceted Intervention to Improve Patient Knowledge and Safe Use of Opioids: Results of the ED EMC2 Randomized Controlled Trial

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Product

Resources

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A Multifaceted Intervention to Improve Patient Knowledge and Safe Use of Opioids: Results of the ED EMC² Randomized Controlled Trial