Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, Iowa, USA Institute for Clinical and Translational Science, The University of Iowa, Iowa City, Iowa, USA.
Department of Computer Science, College of Liberal Arts, The University of Iowa, Iowa City, Iowa, USA.
J Am Med Inform Assoc. 2014 Jul-Aug;21(4):679-86. doi: 10.1136/amiajnl-2013-002284. Epub 2013 Dec 10.
To examine the impact of a personal health record (PHR) on medication-use safety among older adults.
Online PHRs have potential as tools to manage health information. We know little about how to make PHRs accessible for older adults and what effects this will have.
A PHR was designed and pretested with older adults and tested in a 6-month randomized controlled trial. After completing mailed baseline questionnaires, eligible computer users aged 65 and over were randomized 3:1 to be given access to a PHR (n=802) or serve as a standard care control group (n=273). Follow-up questionnaires measured change from baseline medication use, medication reconciliation behaviors, and medication management problems.
Older adults were interested in keeping track of their health and medication information. A majority (55.2%) logged into the PHR and used it, but only 16.1% used it frequently. At follow-up, those randomized to the PHR group were significantly less likely to use multiple non-steroidal anti-inflammatory drugs-the most common warning generated by the system (viewed by 23% of participants). Compared with low/non-users, high users reported significantly more changes in medication use and improved medication reconciliation behaviors, and recognized significantly more side effects, but there was no difference in use of inappropriate medications or adherence measures.
PHRs can engage older adults for better medication self-management; however, features that motivate continued use will be needed. Longer-term studies of continued users will be required to evaluate the impact of these changes in behavior on patient health outcomes.
考察个人健康记录（PHR）对老年人用药安全的影响。
在线 PHR 作为管理健康信息的工具具有一定潜力。我们对如何使 PHR 便于老年人使用以及这将产生什么影响知之甚少。
设计了一个 PHR，并在老年人中进行了预测试，然后在一项为期 6 个月的随机对照试验中进行了测试。在完成邮寄的基线问卷后，符合条件的计算机用户（年龄在 65 岁及以上）以 3:1 的比例随机分配，获得 PHR（n=802）或作为标准护理对照组（n=273）。随访问卷衡量了从基线开始用药变化、用药核对行为和用药管理问题。
老年人对跟踪自己的健康和用药信息很感兴趣。大多数老年人（55.2%）登录并使用了 PHR，但只有 16.1%的人经常使用。在随访时，随机分配到 PHR 组的人使用多种非甾体抗炎药（系统生成的最常见警告，有 23%的参与者查看）的可能性显著降低。与低/非使用者相比，高使用者报告的用药变化明显更多，用药核对行为明显改善，并且明显识别出更多的副作用，但在使用不当药物或药物依从性方面没有差异。
PHR 可以让老年人更好地进行药物自我管理；然而，需要有激励持续使用的功能。需要对持续使用者进行更长期的研究，以评估这些行为变化对患者健康结果的影响。
