Reducing adverse self-medication behaviors in older adults with the Next Generation Personal Education Program (PEP-NG): Design and methodology

Patient Preference and Adherence Dovepress open access to scientific and medical research METHODOLOGY Patient Preference and Adherence downloaded from https://www.dovepress.com/ by 37.59.46.207 on 12-Jul-2018 For personal use only. Open Access Full Text Article Reducing adverse self-medication behaviors in older adults with the Next Generation Personal Education Program (PEP-NG): Design and methodology This article was published in the following Dove Press journal: Patient Preference and Adherence 6 November 2009 Number of times this article has been viewed Patricia J Neafsey 1,2 Elizabeth Anderson 1,2 Craig Coleman 3 Carolyn A Lin 2,4 Cyr E M’lan 5 Stephen Walsh 6 School of Nursing, 2Center for Health Intervention and Prevention (CHIP), 3School of Pharmacy, 4 Department of Communication Sciences, 5Department of Statistics, 6 Center for Nursing Research, School of Nursing, University of Connecticut, Storrs, CT, USA 1 Abstract: A randomized controlled efficacy trial targeting older adults with hypertension is providing a tailored education intervention with a Next Generation Personal Education Program (PEP-NG) in primary care practices in New England. Ten participating advanced practice registered nurses (APRNs) completed online knowledge and self-efficacy measures pre-onsite training and twice more after completing a continuing education program. Patient participants self-refer in response to study recruitment brochures and posters. Twenty-four participants from each APRN practice (total N = 240) are randomly assigned by the PEP-NG software to either control (data collection and four routine APRN visits) or tailored intervention (PEP-NG interface and four focused APRN visits) conditions. Patients access the PEP-NG interface via wireless tablet and use a stylus to answer demographic, knowledge, and self-efficacy questions as well as prescription and over-the-counter self-medication practice questions. The PEP-NG analyzes patient-reported information and delivers tailored educational content. Patients’ outcome measures are self-reported antihypertensive medication adherence, blood pressure, knowledge and self-efficacy concerning potential adverse self-medication practices, adverse self-medication behavior “risk” score and satisfaction with the PEP-NG and APRN provider relationship. APRN outcome measures are knowledge and self-efficacy concerning adverse self-medication practices, self-efficacy for communicating with older adults and satisfaction with the PEP-NG. Time–motion and cost–benefit analyses will be conducted. Keywords: hypertension, self-medication, older adults, tailored intervention, computer-based education Introduction Correspondence: Patricia J Neafsey School of Nursing Unit 2026, University of Connecticut, Storrs, CT 06269 USA Tel +1 860 486 0508 Fax +1 860 486 0001 Email submit your manuscript | www.dovepress.com Dovepress Powered by TCPDF (www.tcpdf.org) Despite frequent primary care visits, adults over the age of 60 years often do not achieve target blood pressure (BP) readings (140/90; 130/80 for those with diabetes or chronic kidney disease).1–5 An estimated $100 billion is spent annually in the United States on health care for patients with poorly controlled BP in part due to poor antihypertensive medication adherence and other adverse self-medication behaviors.6–10 Failure of the health care system to identify and remediate poor adherence and adverse self-medication behaviors adds to the overall cost of treatment as providers typically intensify antihypertensive therapy and add additional agents to the regimen which further increases the risk of adverse drug side effects as well as cost.11,12 Recent trials aimed at improving patient adherence to antihypertensive therapy have yet to demonstrate large long-term improvements in either adherence or health Patient Preference and Adherence 2009:3 323–334 323 © 2009 Neafsey et al, publisher and licensee Dove Medical Press Ltd. This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited. Dovepress Patient Preference and Adherence downloaded from https://www.dovepress.com/ by 37.59.46.207 on 12-Jul-2018 For personal use only. Neafsey et al outcomes.13 Intensive and frequent (monthly) counseling can greatly improve antihypertensive adherence, but adherence declines to baseline when the intervention is removed.14–16 Patient adherence to antihypertensives has been shown to be greatest five days prior and five days after health care visit and usually declines within 30 days to typify the so called “white coat adherence.”7 Inadequate patient education about adherence and safe medication use contributes to preventable adverse drug events.6 Over-the-counter (OTC) medications, supplements, and alcohol can interact with antihypertensives and contribute to poor BP control.6,10,17 For example, nonsteroidal anti-inflammatory drugs (NSAIDS such as ibuprofen) increase BP and antagonize the efficacy of antihypertensives and the anti-platelet effects of lowdose aspirin when taken concurrently.18–20 Many patients choose inappropriate OTC analgesics such as NSAIDs to self-medicate pain.21,22 In separate surveys of English- and Spanish-speaking older adults with hypertension, more than 85% reported two or more adverse self-medication practices.21,22 Older adults with hypertension also had large knowledge deficits regarding conflicts between prescription and OTC agents, as well as low confidence in their ability to avoid these conflicts.23 Addressing adverse self-medication practices is one step toward reducing the risk of potential adverse drug interactions (PADI). A personal computer (PC)-based interactive Personal Education Program (PEP) was effective in improving knowledge and self-efficacy in addition to reducing adverse self-medication practices in older adults with hypertension.24,25 The PEP was upgraded to the “next generation” PEP (PEP-NG), a web-based program accessed wirelessly. The PEP-NG has the following attributes: 1) embedded measurement instruments to capture demographics, medication use, knowledge and self-efficacy about avoiding adverse self-medication behaviors, and satisfaction with the provider relationship and system-interface, and 2) a rules engine that analyzes patient reported information as the basis for delivering a tailored educational intervention to the individual patient. This paper details the design and methods of a clinical trial testing the effectiveness of the PEP-NG in primary care practices. Specifically designed to increase medication adherence and reduce adverse self-medication behaviors in older patients with hypertension, this web-based intervention/education system is the first of its kind. related knowledge and self-efficacy. Patients access the PEP-NG interface via a wireless tablet PCa and use a stylus to interact with a set of medication regimen (prescription and over-the-counter) and self-medica (...truncated)