title: Initial evaluation of a computer-based medication management tool in a geriatric clinic.
abstract: BACKGROUND
  Optimal management of medication regimens remains a challenge for elderly patients and their providers. Tools that aid communication and adherence can be valuable but often do not meet expectations.
  
  
  OBJECTIVE
  The purpose of this article was to describe the development and preliminary evaluation of a computer-based medication management tool, the Visual Medication Profile (VMP), and to report initial feedback from geriatric patient and provider focus groups.
  
  
  METHODS
  For VMP development, an interdisciplinary team (ie, physicians, nurses, pharmacists, computer analysts, and programmers) designed the fully automated, Web-based intervention that integrates the Veterans Affairs Medical Center (VAMC) computer pharmacy system with the computerized patient record system. In addition to development of the required technology, a mixed methods design and a convenience sample were used to collect pilot data related to patient-provider issues about medication management, and the acceptance, feasibility, and usefulness of the VMP. This involved the use of focus groups and a pilot study group.
  
  
  RESULTS
  First, the interdisciplinary team developed the VMP by integrating data from the pharmacy database, the patient's database, and a pill photograph database. Second, patients and providers in the focus groups discussed medication management issues and evaluated a sample VMP. Patients (n = 8; mean age, 76 years; 5 black, 3 white) noted the following medication management problems: (1) not understanding the information provided by the physician; (2) multiple providers; and (3) unpronounceable names of medications. Providers (n = 8 [4 physicians, 4 nurse practitioners]) noted that patients and providers use different language to discuss medications; that there is a lack of congruence between patients' self-report of current medications and their medical record; and that there are severe time constraints for clinic appointments and concern regarding introducing a new clinical tool. Both groups favored a VMP-like tool to improve communication. In the VMP prototype pilot study, a patient-specific VMP was developed for each of 6 subjects (mean age, 79.7 years; 3 black, 3 white) from the outpatient geriatric clinic. Congruence rates ranged from 51% to 100%. Five of the 6 subjects participated in follow-up. The nurse's telephone log from the pilot study revealed that although 4 out of the 5 subjects and/or caregivers reported that they favored the VMP as a medical management tool, the use of the VMP at home varied considerably.
  
  
  CONCLUSIONS
  The VMP is a promising tool for use by both patients and providers to improve medication management. Although it was developed in the VAMC system, its Web-based platform has the potential for export to other systems.
authors.affiliation: School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA. Thomas.Hornick@med.va.gov
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Hornick
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Higgins
authors.forename: Charles
authors.initials: C
authors.lastname: Stollings
authors.forename: Lawrence
authors.initials: L
authors.lastname: Wetzel
authors.forename: Kathryn
authors.initials: K
authors.lastname: Barzilai
authors.forename: Dan
authors.initials: D
authors.lastname: Wolpaw
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D000369:Aged, 80 and over; D016303:Clinical Pharmacy Information Systems / Q000458:organization & administration*; D006299:Health Services for the Aged / Q000458:organization & administration*; D006801:Humans; D020407:Internet; D016347:Medical Records Systems, Computerized / Q000458:organization & administration*; D010348:Patient Care Team; D010353:Patient Education as Topic / Q000379:methods*; D010865:Pilot Projects; D014481:United States; D014493:United States Department of Veterans Affairs