Please select the eligibility criteria that correspond to the clinical trial below.
Title: Medtable: An Electronic Medical Record (EMR) Strategy to Promote Patient Medication Understanding and Use
Brief Summary: The broad goal of this project is to improve knowledge of and adherence to medication regimens and health outcomes among adults with type 2 diabetes or other metabolic disorders. These patients have complex self-care needs, but limited literacy and cognitive skills to meet these needs. Medication error is widespread and costly, and often associated with inadequate patient knowledge about medication, especially among chronically ill adults with limited health literacy. Inadequate knowledge is often traced to limited communication with providers, in part because of barriers such as limited patient contact time and communication training, and lack of system-level support for consistent use of patient-centered strategies. There is a need to leverage information technology (IT) to provide system-based support for patient-centered communication. The investigators will evaluate an Electronic Medical Record (EMR)-based tool (the Medtable) to support provider/patient communication and improve medication knowledge, adherence, and health outcomes among chronically ill adults with complex medication regimens. A paper-based Medtable has been found to help older adults create accurate medication schedules in a simulated patient/provider communication task (Morrow et al., 2008). Benefits for patients should be enhanced if the Medtable is integrated with an EMR, giving providers ready access to relevant background information and current medication lists that patients can update, so providers can generate and tailor the Medtable for a diverse set of patients. This system provides an integrated approach to patient education about medications, from prescribing to counseling during office visits. As a result, patients would not only understand how to take their medications, but develop concrete plans for doing so. Specific aims of the project are: 1) Refine the Medtable prototype for use in an EMR environment. This includes developing protocols for generating patient-specific Medtables and educating providers to use them in medical encounters. 2) Evaluate the Medtable's impact on patient care processes and outcomes. The investigators will test the following hypothesis about communication processes: H1) Patients in the intervention condition will be more satisfied with communication about medication than patients in the usual care condition. The investigators will also test the following hypotheses about patient outcomes: Compared to usual care patients, patients receiving the Medtable intervention will: H2) know more about their medications; H3) adhere more accurately to their medication regimens; H4) more likely have blood glucose (glycosylated hemoglobin, HbA1c) levels in the target range. Aim 1 will be accomplished by interviewing physicians and their patients as the system is refined to ensure ease of using the system, and by collecting preliminary evidence that the Medtable improves patient/provider communication. After establishing initial feasibility and ensuring provider acceptance of the system, Aim 2 is addressed by a randomized trial at the general internal medicine clinics in Chicago and Peoria (IL), comparing patients who use the Medtable with their providers to those receiving usual care.


Options:
A: Inclusion Criteria:

1. Adults, 18 years or older, currently being treated for Type II diabetes
2. HgbA1C greater or equal to 8.0% and at least 1.0% above target within the last 3 months
3. Have a functional email address or be willing to obtain one
4. Be functional in reading the English language (self reported)

Exclusion Criteria:

1. Have Type I diabetes or Latent autoimmune diabetes of adults (LADA)
2. Are on continuous glucose monitoring
3. Have an insulin pump
4. Are on dialysis
5. Are pregnant.
6. Are unable to use a computer or mobile phone due to severe mental or physical impairment
B: Providers:

Physicians will be eligible if they have a significant proportion of patients age 40 or older with metabolic disorders.

Inclusion criteria for nurses will be:

* a current RN, LPN certificate or BSN degree
* practicing at least 10 hours weekly
* providing primary care to adults over age 40 years with chronic illness

This should ensure that we recruit physicians and nurses who teach patients about medication as part of their routine responsibilities.

Patient Participants:

Community-dwelling adults who are patients of participating providers and who meet the following inclusion criteria will participate:

* age 40 and older
* native speaker of English or English speaker before age of 6
* no physical or cognitive impairments that could limit participation (e.g., stroke in the last 3 years, current cancer treatment involving radiation or chemotherapy)
* score of 24 or higher on the Mini Mental State Exam (Folstein, Folstein, \& McHugh, 1975)
* no severe visual impairment (\<20/50 corrected vision) or auditory impairment that would limit participation
* diagnosis of type 2 diabetes or other metabolic disorders (they are also likely to have other chronic illnesses such as hypertension)
* taking at least 5 prescribed medications
* HbA1c level of 7.0 or higher
C: Inclusion Criteria:

* Convenience sample of 11 community health clinics (CHCs) that are members of OCHIN, Inc.

Exclusion Criteria:

* none, for study CHCs
D: Inclusion Criteria:

* Patient of target practices for at least 1 yr defined as having one office visit within preceding 12 month
* Home ZIP code including ANY of the following: 1. 19104 2. 19131 3. 19139 4. 19143 5. 19146
* 2 or more of the following conditions: 1. Obesity (BMI greater than 30), 2. HTN (ICD9 relating to HTN in EMR), 3. DM (ICD9 relating to DM in EMR), 4. Asthma/COPD and tobacco dependence (ICD9 for asthma or COPD in EMR AND documentation of tobacco use)
* Uninsured, insured by Medicaid or dually eligible for Medicaid/Managed Medicare
* Patients who have scheduled appointments in the future.

Exclusion Criteria:

* Will not provide informed consent for this study.
* Does not have the capacity to provide informed consent for this study.
* Previously enrolled in this study

Answer: B