eAlign: A Patient Portal-based Intervention to Align Medications with What Matters Most

PROJECT SUMMARY Older adults with Alzheimer’s disease and related dementias (ADRD) often take multiple medications and use potentially inappropriate medications (PIM), placing them at increased risk of adverse drug events, drug interactions, treatment burden, and mortality. Deprescribing (reducing or stopping medications that are harmful or unlikely to be beneficial) can improve outcomes for people living with dementia (PLWD). The overarching goal of this proposal is to refine and pilot an intervention in which ADRD care partners are identified in primary care and provided with educational materials through the patient portal to engage them in deprescribing for PLWD. We propose a multicomponent intervention, eAlign, which includes: 1) Facilitated patient portal registration for both PLWD and care partners; and 2) delivery of a patient portal intervention to align medication decisions with PLWD and care partners goals, provide care partner training in nonpharmacologic treatment of behavioral and psychological symptoms of dementia, and reduce polypharmacy and PIM use. We propose the following specific aims: In Aim 1, we characterize triadic interactions regarding medication use from two complementary perspectives. In Aim 1a we assess how communication dynamics and characteristics of PLWD and care partners affect uptake of deprescribing recommendations during consultation with a clinical pharmacist. We qualitatively analyze content of 120 audiorecorded visits conducted as part of an ongoing, pharmacist-led deprescribing intervention for PLWD and their care partners in primary care. In Aim 1b we identify individual (PLWD) and contextual (health system, clinic, clinician) factors that affect use of the patient portal for medication management among PLWD by examining uptake and use of the patient portal from date and time-stamped electronic interactions of n=7,500 PLWD receiving primary care in two health systems. In Aim 2, we iteratively refine the eAlign protocol through a user-centered design process involving in-depth interviews with key stakeholders (n=15-20 patient-care partner dyads and 10-15 frontline staff, clinicians, clinical informaticists and health system leaders) at both health care systems. In Aim 3, we will pilot the resultant eAlign protocol with a total of 100 patient-care partner dyads at both health care systems to establish feasibility, acceptability and preliminary efficacy for a future multisite cluster randomized trial. We will conduct a two-group pilot randomized trial to examine feasibility of measuring two primary outcomes (total number of chronic daily medications and rates of PIM prescriptions among PLWD) and one caregiver-reported secondary outcome, the Family Caregiver Medication Administration Hassles Scale. This work will establish the preliminary data, methods, and partnerships to undertake a multisite embedded pragmatic clinical trial of a triadic-based behavioral intervention to promote patient and care partner engagement, foster care that aligns with patients’ values, and promote improved health and well-being outcomes for PLWD and their care partners.