e-ALIGN: A Patient Portal-based Intervention to Align Medications With What Matters Most
Trial Snapshot
- Phase
- Not Applicable
- Status
- Recruiting
- Sponsor
- Johns Hopkins University
- Enrollment
- 100
- Locations
- 1
- Primary Endpoint
- Number of patients who open the patient portal message
Study Overview
Brief Summary
The overarching goal of this study is to pilot an intervention in which older adults with mild cognitive impairment and dementia and the older adult's care partners are identified in primary care and provided with educational materials through the patient portal to engage the participant in deprescribing. The multicomponent intervention, e-Align, includes delivery of educational information through the patient portal, and a pharmacist-led intervention to align medications with patient and care partner goals and reduce use of central nervous system (CNS) potentially inappropriate medicines (PIM). This work will establish the preliminary data, methods, and partnerships to undertake a multisite embedded pragmatic clinical trial. The resulting triadic-based behavioral intervention will promote patient and care partner engagement, and foster care that aligns with patients' values, and promote improved health and well-being outcomes for people with cognitive impairment and the patient's care partners through deprescribing.
Study Design
- Study Type
- Interventional
- Allocation
- Na
- Intervention Model
- Single Group
- Primary Purpose
- Health Services Research
- Masking
- None
Masking Description
Due to the nature of the intervention, participants cannot be masked.
Eligibility Criteria
- Ages
- 65 Years to — (Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- Yes
Inclusion Criteria
- •Patients: Age ≥65, with a diagnosis of MCI or dementia based on ICD-10 codes and ≥1 active CNS-PIM, who are active patient portal users.
- •Care partners:
- •Family or other companions >21 years who regularly help the patient with managing medications.
Exclusion Criteria
- •As the trial will be based in primary care, individuals residing in long term care facilities or enrolled in hospice will be excluded.
Arms & Interventions
Patient Portal Deprescribing Intervention
e-ALIGN will be piloted via the patient portal. The intervention will provide patients and care partners with an educational video on the risks of Central Nervous System-Potentially Inappropriate Medications (CNS-PIM) through the patient portal, MyChart. It will also offer the participant the opportunity to discuss deprescribing options with the patient's primary care physician (PCP) or to receive a referral to discuss deprescribing options with a clinical pharmacist who is embedded in the primary care practice.
Patients who meet with the pharmacist will have two visits (intervention and follow-up). Patients who do not meet with a pharmacist will have a routine visit with the patient's PCP. Each participant will be on study (intervention period and additional follow-up) for approximately 3 months.
Intervention: e-ALIGN Patient-Portal Deprescribing (Other)
Outcomes
Primary Outcomes
Number of patients who open the patient portal message
Time Frame: 1 month after sending message
The investigators will assess the number of patients and/or care partners who read the patient portal message sent by the study team, which invites the participant to meet with a clinical pharmacist for deprescribing.
Number of patients who watch the video
Time Frame: 1 month after sending message
The investigators will assess the number of patients who click and watch the educational video about CNS-PIM and deprescribing.
Acceptability of educational video assessed by survey
Time Frame: 1 month after sending message
The investigators will assess the acceptability of the educational video by administering a survey to participants. The survey will ask participants to rate various features of the video on a 5-point Likert scale, where a higher score indicates greater acceptability.
Secondary Outcomes
- Number of patients or care partners that discussed deprescribing with any clinicians after receiving the message(3 months after sending message)
- Number of PCPs who send the referral(3 months after sending message)
- Number of patients who schedule the pharmacist visit(3 months after sending message)
- Number of patients who deprescribe ≥1 CNS-PIM after receiving the message(3 months after sending message (for patients who do NOT have a pharmacist visit))
- Number of patients who start ≥1 CNS-PIM after receiving the message(3 months after sending message (for people who do NOT have a pharmacist visit))