对认知障碍患者和潜在不适当用药患者的患者门户网站使用情况进行特征描述。
Characterizing patient portal use of people with cognitive impairment and potentially inappropriate medications.
作者信息
Green Ariel R, Martin Daniel, Jessen Andrew, Wu Mingche M J, Daddato Andrea E, Rosado Rosalphie Quiles, Gleason Kelly T, Wec Aleksandra, Wolff Jennifer L, Taylor Casey O, Bayliss Elizabeth A
机构信息
Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Kaiser Permanente Colorado Institute for Health Research, Aurora, Colorado, USA.
出版信息
J Am Geriatr Soc. 2025 Mar;73(3):750-758. doi: 10.1111/jgs.19284. Epub 2024 Nov 23.
BACKGROUND
People with cognitive impairment commonly use central nervous system-active potentially inappropriate medications (CNS-PIM), increasing risk of adverse outcomes. Patient portals may be a promising tool for facilitating medication-related conversations. Little is known about portal use by this population related to medications.
OBJECTIVE
To target portal interventions, we sought to identify individuals with cognitive impairment and CNS-PIM exposure who discussed medications through the portal and to determine how frequently their messages described possible adverse effects.
METHODS
We used electronic health record (EHR) data from an academic health system in Maryland (Site 1) from 2017 to 2022 and pharmacy and EHR data from an integrated health system in Colorado (Site 2) in 2022 to identify people with cognitive impairment and CNS-PIM exposure who communicated about medications through the portal. At Site 1, message threads were manually categorized based on content. At Site 2, messages were categorized using natural language processing (NLP).
RESULTS
The Site 1 cohort included 5543 patients aged ≥65 with cognitive impairment and ≥2 outpatient visits from 2017 to 2022. Over half (n = 3072; 55%) had CNS-PIM prescriptions. Most with CNS-PIM prescriptions had portal use (n = 1987; 65%); 1320 (66%) of those patients sent messages during possible CNS-PIM exposure. Coding of a 5% random sample of message threads revealed that 3% mentioned CNS-PIM and possible adverse effects, while 8% mentioned possible adverse effects without referencing CNS-PIM. At Site 2, 4270 people had cognitive impairment and CNS-PIM exposure in 2022; of these, 1984 (46%) had portal use and 1768 (41%) sent medication-related messages during CNS-PIM exposure. NLP identified 663 (8%) messages that mentioned CNS-PIM and possible adverse effects, while 726 (41%) mentioned possible adverse effects without referencing CNS-PIM.
CONCLUSIONS
People with cognitive impairment and care partners frequently send portal messages about medications and possible adverse effects. Identifying such messages can help target deprescribing interventions.
背景
认知障碍患者通常会使用中枢神经系统活性潜在不适当药物（CNS-PIM），这会增加不良后果的风险。患者门户网站可能是促进与药物相关对话的一个有前景的工具。对于这一人群使用门户网站处理药物相关事宜的情况，我们知之甚少。
目的
为了针对门户网站干预措施，我们试图识别出有认知障碍且接触过CNS-PIM并通过门户网站讨论药物的个体，并确定他们的信息中描述可能的不良反应的频率。
方法
我们使用了2017年至2022年来自马里兰州一家学术医疗系统（站点1）的电子健康记录（EHR）数据，以及2022年来自科罗拉多州一家综合医疗系统（站点2）的药房和EHR数据，以识别有认知障碍且接触过CNS-PIM并通过门户网站交流药物相关事宜的人。在站点1，根据内容对手动分类的消息线程进行分类。在站点2，使用自然语言处理（NLP）对消息进行分类。
结果
站点1队列包括2017年至2022年期间年龄≥65岁、有认知障碍且门诊就诊≥2次的5543名患者。超过一半（n = 3072；55%）有CNS-PIM处方。大多数有CNS-PIM处方的患者使用过门户网站（n = 1987；65%）；其中1320名（66%）患者在可能接触CNS-PIM期间发送了消息。对5%的消息线程随机样本进行编码后发现，3%提到了CNS-PIM和可能的不良反应，而8%提到了可能的不良反应但未提及CNS-PIM。在站点2，2022年有4270人有认知障碍且接触过CNS-PIM；其中，1984名（46%）使用过门户网站，1768名（41%）在接触CNS-PIM期间发送了与药物相关的消息。NLP识别出663条（8%）提到CNS-PIM和可能的不良反应的消息，而726条（41%）提到了可能的不良反应但未提及CNS-PIM。
结论
有认知障碍的患者及其护理伙伴经常通过门户网站发送有关药物和可能的不良反应的消息。识别这些消息有助于针对性地进行减药干预。
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