Measuring Consumer Access to
Medication Information Online
AcademyHealth Annual Research Meeting
Sarah J. Shoemaker, PhD, PharmD
June 28, 2010
Background
• There have been advances in the availability of Personal
), which are available via health care
Health Records ((PHRs),
providers, health care systems or independent platforms.
• California Healthcare Foundation national survey of 1,849
adults found that 7% have used a PHR [1]
• However, the extent to which people access and use
medication information in PHRs is unknown
• In order to measure impact of PHRs on outcomes, must first
assess:
– the extent to which patients have access to PHRs,
– whether various functionalities are offered on PHRs
PHRs, and
– the degree to which consumers use these functionalities.
Abt Associates
Objective
• Support of AHRQ's Measurement of Health IT progress
• Measurement Objective
– To develop and field a survey to obtain a national estimate
of the number of U.S. adults who have access to their
medication information online.
• We did not field the survey
• Therefore, this presentation will:
– Describe the process used to develop the survey
– Cog
Cognitive
t e testing
test g results
esu ts
– Conceptual issues that had to be addressed
Abt Associates
Next Steps: Consumer Access to their Medication
Information Online
Adoption
Setting
N/A
(Public)
and
Technology of
Interest
Online medication
records (personal
health records)
Abt Associates
Use//
U
Meaningful Use
Operational
definition
Operational
definition
# of U.S. Adults who
have used a patient
portal or PHR to
obtain online info
about their prescribed
medications
Use of various
functionalities of
online medication
records (e.g. refills,
check drug-drug
interactions, etc.)
Data Source
Data Source
Develop or expand
existing survey
Develop or expand
existing survey
Analysis Method
Analysis Method
Sample proportions
adjusted for sampling
weights & nonresponse
Averages adjusted
for non-response plus
p arithmetic
simple
Outcomes
Operational
definition
Medication errors
TBD
Data Source
Secondary data
Medical records
A l i M
Analysis
Method
th d
TBD
Survey Development Process
• Construct clarification
• Determine survey domains
• Developp surveyy items for each domain
• Cognitively test survey with adults
• Revise survey items based on cognitive testing
• Field
Fi ld survey
Abt Associates
Construct Clarification
• Original Measure: The proportion of persons in the U.S.
who can access their medication information online
online.
– Persons: Any adult (over age 18) residing in the United
States.
States
– Access: availability and use (of patient portal or PHR)
– Medication Information: A personal record the patient has
access to that contains the past and present prescribed
medications. (Synonyms: medication list or medication
record).
• Medication: prescription medication or a medication
that has been prescribed
Abt Associates
Construct Clarification
• Online: via a patient portal or personal health record accessed
remotely through an electronic device with internet or intranet
access (e.g., computer, PDA, Smartphone).
– Patient p
portal: An internet or intranet site that offers p
patients
services such as Web links to reliable sources of medical
information, and the ability to make appointments, obtain
managed care referrals, and request medication renewals.”[2]
renewals. [2]
– Personal health record (PHR): Electronic summaries of a
patient’s medical record that are often portable and easily
accessed by the patient.”[3]
• Operational Definition:
Definition The n
number
mber of U
U.S.
S ad
adults
lts who
ho
have used a patient portal or PHR to obtain information
online about their past or present prescribed medications
medications.
Abt Associates
Survey Domains
•
PHR or patient portal
– A
Availability
il bilit i) IInternet
t
t and
d ii) PHR or patient
ti t portal
t l
– Use
– Functionality (e.g., schedule appointment)
– Source ((i.e., who maintains the PHR/portal)
p
)
•
Medication therapy information
– Availability
– Use
– Functionality (e.g., refills, check drug-drug interactions, etc.)
•
Respondent socio-demographics
Abt Associates
Survey Design
• Survey Attributes
– Mode: telephone random-digit dial (RDD)
– Languages: English and Spanish
– Length: 10-minutes
– Domains: 3
– Items: 14 items
Abt Associates
Cognitive Testing
• Cognitive testing was performed to assess:
– how well respondents understood each question as
intended
– how readily they could recall relevant information
– whether they could use that information to come up with an
answer
– whether they could report that answer in the format
required by the questionnaire
• Two
T
rounds
d off cognitive
iti testing
t ti with
ith 16 di
diverse patients
ti t
Abt Associates
Cognitive Testing Participants
Round 1
Round 2
Total
6
2
6
2
12
4
46
26 65
26-65
42
27 56
27-56
44
26 65
26-65
Education
More than high school
High school or less
2
6
5
3
7
9
Race/ethnicity
Non-Hispanic White
Non-Hispanic Black
Hispanic
3
3
2
3
2
3
6
5
5
Gender
Male
Female
3
5
5
3
8
8
PHR or p
patient p
portal access
PHR only
Portal only
PHR and portal
None
0
4
2
2
1
3
3
1
1
7
5
3
8
8
16
Primary language
E li h
English
Spanish
Age
Mean age
A
Age
range
N
Abt Associates
Issues Identified & Solutions Proposed
• Survey Question:
Do you have access to an on-line
on line record of your personal health
information?
 Yes
 No
 Don't know
• Cognitive Testing Finding:
– When asked this qquestion,, several women defined the term as
including their personal information plus their family members’.
• Solution: Clarified in a statement before the survey question that we
were only asking about the respondent's information and not his/her
family's information.
Abt Associates
Issues Identified & Solutions Proposed
• Survey Question:
Does your online health record include information about the medications you
are currently taking or have been prescribed?
 Yes
 No
 Don't know
 I don
don’tt take medications or have never taken medications
• Cognitive Testing Findings:
– There is no one accepted term to refer to online records that
might include medication information.
– Wording needs to include patient entering information.
• Solution (revised Q): Is there a place in your on-line
on line personal health
record for information about the medications prescribed for you?
Abt Associates
Issues Identified & Solutions Proposed
• Survey Question:
Which of the following people or organizations maintain this on-line
on line record for
you? Please answer yes or no for each of the following:
 Your doctor, nurse or other health care provider
 Your health plan or health insurance company
 Your employer
 Your
Y
pharmacy
h
 Other (please specify)
• Cognitive Testing Findings:
– Respondents thought government agency should be included.
– Respondents were alarmed by employer as an option.
• Solution:
S l ti
Add d ""governmentt agency"" & removed
Added
d ""employer"
l
" options
ti
Abt Associates
Issues Identified & Solutions Proposed
• Survey Question:
In several survey questions we referred to "on-line
on line record"
record
• Cognitive Testing Findings for Spanish-speakers:
– While "record" is recognized by younger persons, "expediente" is
recognized by older persons.
– Also, "en línea" (online) is used primarily by younger persons
• Solutions:
– Used "record or expediente”
– Replaced “en línea” by “en el internet” (on the internet), which is
an older term recognized by younger and older persons.
Abt Associates
Discussion
• Our two rounds of cognitive testing results demonstrate:
– challenges for respondents to understand certain Health IT
terms (e.g., on-line record)
– difficulty of surveying respondents on a HIT technology that
many of them have not seen or used (e.g., PHRs)
– importance of using different terms for different languages
to ensure comprehension and cultural appropriateness
– importance of thoughtfully assessing respondents’
understanding and interpretation of Health IT in consumer
surveys.
surveys
Abt Associates
Implications for Health IT Measurement
• While it is critical to assess the outcomes of HIT like
PHRs, we first must understand and measure the extent
PHRs
to which consumers have access to and use these
technologies.
• We have demonstrated,, from our experience,
p
, that in order
to obtain valid & reliable estimates of HIT adoption & use:
– Carefullyy clarifyy constructs since manyy HIT constructs are
likely to be interpreted differently
– Cognitive
g
testing
g with consumers is valuable to clarify
y the
understanding and interpretation of specific items
Abt Associates
Abt Associates
References
1. California Healthcare Foundation (April 2010). Consumers and Health
Information Technology: A National Survey
2. Weingart SN, Rind D, Tofias Z, Sands DZ. (2006). Who uses the
patient
ti t internet
i t
t portal?
t l? The
Th PatientSite
P ti tSit Experience.
E
i
JA
Am M
Med
d IInform
f
Assoc. 13(1):91-95.
3. Endsley et al. An introduction to personal health records. Family
Practice Management, May 2006;57-62.
Abt Associates