Characterizing patient portal use of people with cognitive impairment and potentially inappropriate medications

IF 4.3 2区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of the American Geriatrics Society Pub Date : 2024-11-23 DOI:10.1111/jgs.19284

Ariel R. Green MD, PhD, MPH, Daniel Martin MA, Andrew Jessen MS, Mingche M. J. Wu MPH, Andrea E. Daddato PhD, MS, Rosalphie Quiles Rosado PhD, Kelly T. Gleason PhD, RN, Aleksandra Wec BA, Jennifer L. Wolff PhD, Casey O. Taylor PhD, Elizabeth A. Bayliss MD, MSPH

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引用次数: 0

Abstract

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.

查看原文本刊更多论文

了解认知障碍患者门户网站的使用特点以及潜在的用药不当。

背景：认知障碍患者通常使用中枢神经系统活性药物（CNS-PIM），这增加了不良后果的风险。患者门户网站可能是促进用药相关对话的有效工具。但人们对这一人群使用门户网站进行药物治疗的情况知之甚少：为了有针对性地采取门户网站干预措施，我们试图找出那些通过门户网站讨论药物的认知障碍患者和 CNS-PIM 暴露者，并确定他们在信息中描述可能的不良反应的频率：我们使用了马里兰州一家学术医疗系统（站点 1）2017 年至 2022 年的电子健康记录（EHR）数据，以及科罗拉多州一家综合医疗系统（站点 2）2022 年的药房和 EHR 数据，以识别通过门户网站交流药物的认知障碍患者和 CNS-PIM 暴露者。在站点 1，根据内容对消息线程进行人工分类。在网站 2，使用自然语言处理（NLP）对信息进行分类：网站 1 的队列包括 5543 名年龄≥65 岁、有认知障碍且在 2017 年至 2022 年期间门诊就诊次数≥2 次的患者。半数以上（n = 3072；55%）开具了 CNS-PIM 处方。大多数具有 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 期间发送了信息。对 5% 的随机信息样本进行编码后发现，3% 的信息提及 CNS-PIM 和可能的不良反应，8% 的信息提及可能的不良反应，但未提及 CNS-PIM。在站点 2，有 4270 人在 2022 年出现认知障碍并接触过 CNS-PIM；其中，1984 人（46%）使用过门户网站，1768 人（41%）在接触 CNS-PIM 期间发送过与药物相关的信息。NLP发现663条（8%）信息提到了CNS-PIM和可能的不良反应，726条（41%）信息提到了可能的不良反应，但没有提到CNS-PIM：结论：认知障碍患者和护理伙伴经常通过门户网站发送有关药物和可能不良反应的信息。识别这些信息有助于有针对性地采取处方干预措施。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the American Geriatrics Society 医学-老年医学

CiteScore

10.00

自引率

6.30%

发文量

504

审稿时长

3-6 weeks

期刊介绍： Journal of the American Geriatrics Society (JAGS) is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy—all supporting the high-quality, person-centered care essential to our well-being as we age. Since the publication of our first edition in 1953, JAGS has remained one of the oldest and most impactful journals dedicated exclusively to gerontology and geriatrics.