A pilot program at the worksite to reduce adverse self-medication behaviors

A Next Generation Personal Education Program (PEP-NG) that captures self-reported medication behaviors and delivers a tailored educational intervention on a touchscreen interface was piloted with 11 adults with hypertension, aged 45–60 years, in a worksite setting. A time series design with multiple institution of treatment (four visits over three months) was employed. Blood pressure (BP), self-medication behaviors, self-efficacy, and knowledge for avoiding adverse self-medication behaviors were assessed at each of four visits. Satisfaction was assessed once at visit 4. Measures pre-PEP (visit 1) to visit 4 were compared with paired t-tests. The adverse self-medication behavior risk score decreased significantly from visit 1 to visit 4 (p < 0.05) with a medium effect size. Both knowledge and self-efficacy for avoiding adverse self-medication behaviors increased significantly (p < 0.05) with large effect sizes. All six participants not at BP goal (<140/90 mmHg) on visit 1 were at goal by visit 4. User satisfaction was high as assessed by both quantitative measures and qualitative interviews. These positive results suggest the PEP could play a central role in worksite wellness programs aimed at workers with hypertension

Reducing Adverse Self-Medication Behaviors in Older Adults with Hypertension: Results of an e-health Clinical Efficacy Trial

A randomized controlled efficacy trial targeting older adults with hypertension (age 60 and over) provided an e-health, tailored intervention with the “next generation” of the Personal Education Program (PEP-NG). Eleven primary care practices with advanced practice registered nurse (APRN) providers participated. Participants (N = 160) were randomly assigned by the PEP-NG (accessed via a wireless touchscreen tablet computer) to either control (entailing data collection and four routine APRN visits) or tailored intervention (involving PEP-NG intervention and four focused APRN visits) group. Compared to patients in the control group, patients receiving the PEP-NG e-health intervention achieved significant increases in both self-medication knowledge and self-efficacy measures, with large effect sizes. Among patients not at BP targets upon entry to the study, therapy intensification in controls (increased antihypertensive dose and/or an additional antihypertensive) was significant (p = .001) with an odds ratio of 21.27 in the control compared to the intervention group. Among patients not at BP targets on visit 1, there was a significant declining linear trend in proportion of the intervention group taking NSAIDs 21–31 days/month (p = 0.008). Satisfaction with the PEP-NG and the APRN provider relationship was high in both groups. These results suggest that the PEP-NG e-health intervention in primary care practices is effective in increasing knowledge and self-efficacy, as well as improving behavior regarding adverse self-medication practices among older adults with hypertension

A qualitative study of older adults and computer use for health education: ‘It opens people’s eyes’

Adults over the age of 60 struggle with achieving target blood pressure readings due to difficulties seeing, hearing and understanding medical information which can result in poor adherence and drug interactions that can be fatal. According to the Institute of Medicine (2000) approximately 10% of adverse drug events may be attributed to communication failure between the provider and patient. Informing patients of potential drug interactions with over-the-counter (OTC) medications, supplements and alcohol use can contribute to better blood pressure control. The Next Generation Personal Education Program (PEP-NG) was designed to improve patient care by educating both older adults and their providers about the dangers of adverse drug interactions arising from self-medication. This web based program analyzes information entered by the patient user (with a stylus on a tablet computer) and delivers tailored interactive educational content applicable to the user’s reported medication behaviors. This qualitative study demonstrated that even amongst participants that may not feel computer literate (older-age generation) it can be a useful tool for information dissemination and also a successful way to improve communication between provider and patient

Using an e-health intervention to enhance patient visits for hypertension: The nurse practitioner perspective

This article reports the findings from interviews with 11 nurse practitioners (NPs) who provided an in-office, e-health intervention as part of a randomized clinical trial aimed at improving medication adherence and reducing adverse self-medication behaviors in older adults with hypertension. The NPs\u27 perspective of their experience with training for the research protocol, recruitment of patient participants, implementing the e-health intervention, and patient response was elicited through open-ended questions in individual face-to-face tape recorded interviews

Reducing adverse self-medication behaviors in older adults with the Next Generation Personal Education Program (PEP-NG): Design and methodology

Patricia J Neafsey1,2, Elizabeth Anderson1,2, Craig Coleman3, Carolyn A Lin2,4, Cyr E M&amp;rsquo;lan5, Stephen Walsh61School of Nursing, 2Center for Health Intervention and Prevention (CHIP), 3School of Pharmacy, 4Department of Communication Sciences, 5Department of Statistics, 6Center for Nursing Research, School of Nursing, University of Connecticut, Storrs, CT, USAAbstract: A randomized controlled efficacy trial targeting older adults with hypertension is providing a tailored education intervention with a Next Generation Personal Education Program (PEP-NG) in primary care practices in New England. Ten participating advanced practice registered nurses (APRNs) completed online knowledge and self-efficacy measures pre-onsite training and twice more after completing a continuing education program. Patient participants self-refer in response to study recruitment brochures and posters. Twenty-four participants from each APRN practice (total N = 240) are randomly assigned by the PEP-NG software to either control (data collection and four routine APRN visits) or tailored intervention (PEP-NG interface and four focused APRN visits) conditions. Patients access the PEP-NG interface via wireless tablet and use a stylus to answer demographic, knowledge, and self-efficacy questions as well as prescription and over-the-counter self-medication practice questions. The PEP-NG analyzes patient-reported information and delivers tailored educational content. Patients&amp;rsquo; outcome measures are self-reported antihypertensive medication adherence, blood pressure, knowledge and self-efficacy concerning potential adverse self-medication practices, adverse self-medication behavior &amp;ldquo;risk&amp;rdquo; score and satisfaction with the PEP-NG and APRN provider relationship. APRN outcome measures are knowledge and self-efficacy concerning adverse self-medication practices, self-efficacy for communicating with older adults and satisfaction with the PEP-NG. Time&amp;ndash;motion and cost&amp;ndash;benefit analyses will be conducted.Keywords: hypertension, self-medication, older adults, tailored intervention, computer-based educatio

Genetic diversity and protective efficacy of the RTS,S/AS01 malaria vaccine

The RTS,S/AS01 vaccine targets the circumsporozoite protein of Plasmodium falciparum and has partial protective efficacy against clinical and severe malaria disease in infants and children. We investigated whether the vaccine efficacy was specific to certain parasite genotypes at the circumsporozoite protein locus.; We used polymerase chain reaction-based next-generation sequencing of DNA extracted from samples from 4985 participants to survey circumsporozoite protein polymorphisms. We evaluated the effect that polymorphic positions and haplotypic regions within the circumsporozoite protein had on vaccine efficacy against first episodes of clinical malaria within 1 year after vaccination.; In the per-protocol group of 4577 RTS,S/AS01-vaccinated participants and 2335 control-vaccinated participants who were 5 to 17 months of age, the 1-year cumulative vaccine efficacy was 50.3% (95% confidence interval [CI], 34.6 to 62.3) against clinical malaria in which parasites matched the vaccine in the entire circumsporozoite protein C-terminal (139 infections), as compared with 33.4% (95% CI, 29.3 to 37.2) against mismatched malaria (1951 infections) (P=0.04 for differential vaccine efficacy). The vaccine efficacy based on the hazard ratio was 62.7% (95% CI, 51.6 to 71.3) against matched infections versus 54.2% (95% CI, 49.9 to 58.1) against mismatched infections (P=0.06). In the group of infants 6 to 12 weeks of age, there was no evidence of differential allele-specific vaccine efficacy.; These results suggest that among children 5 to 17 months of age, the RTS,S vaccine has greater activity against malaria parasites with the matched circumsporozoite protein allele than against mismatched malaria. The overall vaccine efficacy in this age category will depend on the proportion of matched alleles in the local parasite population; in this trial, less than 10% of parasites had matched alleles. (Funded by the National Institutes of Health and others.)