使用患者门户网站在痴呆症患者及其护理伙伴之间讨论药物治疗。
Use of the Patient Portal to Discuss Medications Among People with Dementia and Their Care Partners.
作者信息
Green Ariel R, Wec Aleksandra, Gleason Kelly T, Gamper Mary Jo, Wu Mingche M J, Wolff Jennifer L
机构信息
Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Mason F. Lord Center Tower, 7th Floor, 5200 Eastern Avenue, Baltimore, MD, 21224, USA.
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
出版信息
J Gen Intern Med. 2024 Dec;39(16):3164-3171. doi: 10.1007/s11606-024-09064-3. Epub 2024 Oct 1.
BACKGROUND
People with dementia (PWD) often use potentially inappropriate medications (PIM), exposing them to harm. Patient portals are a promising platform for delivering deprescribing educational interventions to reduce PIM use, yet little is known about how PWD and their care partners use patient portals to communicate with clinicians about medications.
OBJECTIVE
To characterize the content of patient portal messages relating to medications among PWD, care partners, and clinicians, to inform development of a portal-based intervention to reduce use of PIM among PWD.
DESIGN
Descriptive analysis of data from the electronic health record and qualitative analysis of patient portal messages.
PARTICIPANTS
Adults 65 and older, categorized as having dementia based on EHR algorithm, who received care in an academic health system from 2017 to 2022.
APPROACH
Electronic health record data were analyzed using descriptive statistics. Qualitative coding identified topics raised in portal messages.
KEY RESULTS
A total of 399 message threads from 159 unique patients were analyzed. Patients were on average 78.4 years old (SD 8.0). Most (65%) were female, White (76%), and non-Hispanic/Latinx (96%); 15% had a registered proxy portal user. The most common topics raised in portal messages were logistics (42%), concerns about adverse effects/treatment burden (25%), asking for new medications (23%), and openness to stopping medications (21%). Qualitative analysis revealed three main themes related to deprescribing: (1) Opportunities to deprescribe, (2) challenges to deprescribing, and (3) medication-related counseling in the portal.
CONCLUSIONS
PWD and their care partners frequently raise medication concerns in the portal, suggesting it is a promising platform for delivering deprescribing interventions for this population. Future research should identify characteristics of portal-based interventions that would best support deprescribing for PWD and develop pragmatic workflows.
背景
痴呆症患者（PWD）经常使用潜在不适当的药物（PIM），这使他们面临伤害风险。患者门户网站是提供减药教育干预措施以减少PIM使用的一个有前景的平台，但对于PWD及其护理伙伴如何利用患者门户网站与临床医生就药物进行沟通，我们知之甚少。
目的
描述PWD、护理伙伴和临床医生之间与药物相关的患者门户网站消息内容，为开发基于门户网站的干预措施以减少PWD中PIM的使用提供信息。
设计
对电子健康记录数据进行描述性分析，并对患者门户网站消息进行定性分析。
参与者
65岁及以上的成年人，根据电子健康记录算法被归类为患有痴呆症，他们在2017年至2022年期间在学术健康系统接受护理。
方法
使用描述性统计分析电子健康记录数据。定性编码确定门户网站消息中提出的主题。
主要结果
共分析了来自159名独特患者的399个消息线程。患者平均年龄为78.4岁（标准差8.0）。大多数（65%）为女性、白人（76%）、非西班牙裔/拉丁裔（96%）；15%有注册的代理门户网站用户。门户网站消息中提出的最常见主题是后勤问题（42%）、对不良反应/治疗负担的担忧（25%）、要求开新药（23%）以及对停药的接受度（21%）。定性分析揭示了与减药相关的三个主要主题：（1）减药机会，（2）减药挑战，以及（3）门户网站中的药物相关咨询。
结论
PWD及其护理伙伴经常在门户网站中提出药物相关问题，这表明它是为该人群提供减药干预措施的一个有前景的平台。未来的研究应确定最能支持PWD减药的基于门户网站的干预措施的特征，并制定实用的工作流程。
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