Providers do not have the time in the typical 14 minute primary care visit to query patients about their self-medication behaviors, look up all of the potential adverse effects and interactions, prioritize the information, educate the patient, and offer a set of corrective strategies. As a result, the patient’s “shadow regimen” of medication taking behaviors (including over-the-counter agents, supplements, and alcohol) is not attended to and is largely undocumented.
Professor Patricia J. Neafsey, RD, PhD and collaborators with expertise in visual communication design, software usability testing, gerontology, and psychometrics set out in 1991 to design and test an interactive learning software program to enable older adults to avoid adverse self-medication behaviors. With funding from the University of Connecticut Research Foundation and the Donaghue Medical Foundation, the research team developed Preventing Medicine Conflicts, an interactive learning software program to enable older adults with hypertension to avoid drug-interactions. Older adults accessed Preventing Medicine Conflicts on IBM Thinkpad laptops (retrofitted with touchscreens) in a rigorous clinical trial. Users of Preventing Medicine Conflicts demonstrated increased knowledge and self-efficacy concerning potential adverse self-medication practices and reported fewer adverse medication behaviors compared to older adults receiving conventional care. The International Medical Informatics Society gave the research team a “Best of Medical Informatics” citation in 2003.
In 2005, The NIH National Heart Lung and Blood Institute (NHLBI) funded a 5-year Health Literacy study to develop and test a web-based intervention to improve patient adherence to antihypertensive regimens and reduce adverse self-medication behaviors. The next-generation Personal Education Program (PEP-NG) captures patient self-medication behaviors on a touch-sensitive tablet PC. The rules engine analyzes patient-entered information, prioritizes the adverse behaviors found, and delivers interactive educational content tailored to the reported behaviors. Summaries of self-reported symptoms, medication use (including frequency/time), drug interactions, and corrective strategies with an illustration of the drug interaction are printed to inform the provider prior to the primary care visit and for the patient to take home for self-study.
The PEP-NG was subjected to formal usability testing and two separate beta trials with adults with hypertension aged 45-60 and aged 60 and over. The PEP-NG clinical efficacy trial was conducted in 10 primary care practices in CT. Taken together, results suggest that, in addition to increasing knowledge and self-efficacy for avoiding adverse self-medication behaviors and high user satisfaction, the solution is associated with improved self-reported antihypertensive adherence and a two-fold greater reduction in blood pressure (BP) among participants not at BP goal upon study entry compared to participants receiving usual care. Research is continuing to determine the long-term cost-benefit of the PEP-NG in terms of reduced healthcare costs.
To date, the PEP-NG is represents of over 1.3 million in funding, 32 peer reviewed publications and 22 research presentations. The solution is the first “bottom-up” approach (i.e. getting information from the patient, rather than from prescribing information) to address the patient’s “shadow regimen” arising from self-medication. The PEP-NG is the first of its kind to prioritize the relative risk of the potential drug interactions identified and offer a targeted and tailored education program addressing adverse self-medication behaviors.In February of 2009, ActualMeds Corporation was formed to bring this technology to the market for chronic disease monitoring and management. The Company has begun to scale the architecture to a high-availability Software as a Service ( SaaS) platform that can augment patient-provider interaction and improve response to therapy.