Developing Effective Personal Health Applications for the Older Adult

Flexibility, easy-to-understand information, and pharmacist involvement desired

Personal health applications should facilitate communication between patients, physicians, and pharmacists, enable patients to disclose medical information to different clinicians, and provide links to trustworthy medication-related resources, according to a study published recently in the Journal of Medical Internet Research.

Medication management is a challenging clinical issue, especially in older adults who are most likely to have multiple comorbidities. Personal health applications (PHAs), which use information technologies to help patients create their own personal health data, have shown some promise for this purpose in the past, but barriers remain. The authors of the current study sought to investigate older adults' needs, preferences, and practices and how they might be addressed through electronic PHAs. They recruited participants from four sites in the Denver and Boulder, Colorado areas: one geriatric clinic, one senior citizen center, and two assisted/independent living facilities. Inclusion criteria were English fluency, ability to pass a brief cognitive test, openness to use of a PHA, age 65 years or older, at least three prescription medications, two or more outpatient visits in the prior year, and one or more chronic medical condition.

Five themes emerged from the series of semi-structured focus groups and interviews with 32 adult patients and two adult family caregivers. They sought reliable medical information, and they expressed that they trusted their pharmacist the most, followed by their physician. Despite acknowledging their own mental and physical decline and the often overwhelming nature of medication regimens, they wanted to be autonomous in their medication treatment decisions. Participants were worried about taking too many medications and did not generally feel that their provider shared these concerns. They sometimes made the decision on their own to wean themselves or a loved one from some medications. They also had trouble reconciling information discrepancies from allopathic and alternative medicine therapies and coordinating advice from multiple providers.

The authors concluded from these findings that medication management PHAs for older adults should provide the following features:

• Indication and potential side effect information, written for a lay audience rather than in the style of the package insert;
• Ability for patients to document adverse effects and assess appropriateness of a drug via automated analysis or consultative services;
• Communication with pharmacists to receive advice and share questions;
• Flexibility so that users can edit medication lists to reflect any changes they have made; and
• The option to selectively disclose medication information to different practitioners.

Source: Haverhals LM, Lee CA, Siek KA, et al. 2011. Older adults with multi-morbidity: medication management processes and design implications for personal health applications. Journal of Medical Internet Research 13(2):e44.