Effectiveness of a Medication Wallet Card

Study Overview
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Brief Summary
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This study evaluates whether or not the use of a medication wallet card in patients over 70 taking 5 or more medications promotes self-efficacy with regards to coping with illness, understanding medications, and staying healthy. Half of the participants will receive an individualized medication wallet card with their medications and medical conditions listed while the other half will receive a simple reminder card.

Detailed Description
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In order to prevent medication errors and subsequent ADEs, a complete and accurate medication list must be maintained. Although electronic healthcare records, maintained by healthcare providers, have been praised for their potential to decrease medication errors, studies show that the sole implementation of a paperless system is not sufficient to eliminate medication recording and prescription errors. Hence, an approach to maintain complete medication lists will need to involve the cooperation of both health care providers and patients. A previous study showed that an integrated approach including all members of the healthcare team and the patient improved the completeness and accuracy of medication list from 7.7% to 18.5%. One way to increase patient involvement in medication reconciliation is by allowing the patients to become more informed about their health and medications. According to the Bandura's Social Cognitive Theory of Self-Efficacy, the beliefs a person holds regarding his or her power to influence situations strongly affects the agency a person has to face challenges capably. A tool such as an up-to-date MWC that has a list of the medications and dosages in addition to medical conditions listed may help older patients to better understand and manage their health. Furthermore, a wallet card has been an effective tool with many benefits. For example, a study showed that a Medication Allergy Profile card increased patient's knowledge of their drug regimens, decreased medication errors, decreased drug interactions, and improved patients' compliance. No randomized control trials currently show the the impact of a medication wallet card/list on patient enablement. One study showed that a significant percentage of the patients were willing to use a self-maintained wallet-sized medication list. In addition, those who used the medication list showed an improved sense of knowledge about their medical problems and medication, and also exhibited an enhanced sense of responsibility in maintaining their medication lists. However, the study considered a relatively young population that only included patients over the age of 40 and did not stipulate a minimum number of medications for the patients to be taking. In addition, the study was not a randomized control trial, and used the Patient Medication Scale (PMS) to measure outcomes. Hence, a randomized control trial employing a standardized questionnaires to investigate an older population (age greater than 70) experiencing polypharmacy is needed to asses the impact of a medical wallet card in promoting self efficacy and patient enablement.

Official Title
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Effectiveness of a Medication Wallet Card

Conditions
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Comorbidity, Medication Therapy Management, Polypharmacy

Intervention / Treatment
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* Device: Medication Wallet Card
* Device: Reminder Card


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Aged 70 years of age or older Participating family doctor as most responsible provider Patient of McMaster Family Health Team Currently taking 5 or more medications Have not had a recent comprehensive medication review Patient consents Exclusion Criteria: English language or cognitive skills inadequate to understand and respond to rating scales Terminal illness or other circumstance precluding 13 month study period

Ages Eligible for Study
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Minimum Age: 70 Years
Maximum Age: 116 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Wallet Card Group<br>The intervention arm is comprised of: Patients from the TAPER study who receive a medication wallet card with their medications and medical conditions listed. | Device: Medication Wallet Card<br>* A medication wallet card will be given to the intervention group. This will be personalized for each patient and will include the patient's medications, dosages, and medical conditions. It will be personally given to a patient after a medical appointment with their family physician.<br>|
| Placebo Comparator: Control Group<br>Standard of care as well as wait list control. These participants will receive a reminder wallet card which states, Remember to keep an up-to-date listing of your medications and bring your medications to your doctor's appointments. | Device: Reminder Card<br>* A reminder card will be given to this group. The card will not be personal and will be mailed to patients. It will state, Remember to keep an up-to-date listing of your medications and bring your medications to your doctor's appointments.<br>* Other names: Placebo Intervention;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patient Enablement Index | Patient Enablement Index | 4 weeks | 
| Patient Enablement Index | Patient Enablement Index Repeated | 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Usability - Qualitative Data | Survey questions by telephone assessing the usability of a medication wallet card. Questions include: How clear was your medication wallet card? How did you use your medication wallet card over the past four weeks? Did your medication wallet card help you over the past four weeks? If so, how? Do you intend on continuing to carry your medication wallet card? | 4 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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polypharmacy, wallet card, medication, self-efficacy, patient enablement