PS1-28: Optimizing Health Informatics Interventions From the Patient's Perspective: Focus Group on Improving Safe NSAID Use

Abstract

Background: Patient-provider messaging in an electronic medical record (EMR) system provides an opportunity to create and sustain productive patient-provider interactions. We elicited patient perspectives on design, benefits, and concerns to improve usability and efficacy of a proposed health informatics intervention to support surveillance of, and provider feedback on, over the counter (OTC) non-steroidal anti-inflammatory drug (NSAID) use. Methods: We conducted four focus groups involving Kaiser Permanente Georgia (KPG) adults 25–70 years old who had a medical condition for which NSAIDs should be used cautiously or had a recent prescription for NSAIDs. The focus group elicited information regarding: OTC NSAID use (including recognition of risks and side effects), design of an OTC NSAID survey to be delivered via KP.Org (the secure KP Internet portal for patient- physician messaging), benefits and concerns about transmission of this information via electronic messaging to their primary care physicians, and willingness to participate in a health informatics intervention to improve safe NSAID use. We then developed a concept map and classification scheme for analyzing transcripts from the focus groups. Two trained coders labeled the transcripts using ATLASti. Results: Forty-eight KPG adults participated in the focus groups: 83% female; 50% African American; median age 54 years. Fortyseven participants indicated current or recent use of OTC NSAIDs. Easy access to OTC NSAIDs (low cost, no prescription required) promoted their use; however, self-medication strategies often combined multiple OTC NSAIDs or increased OTC NSAID dosing to obtain pain relief. Participants acknowledged that the proposed intervention would benefit their health care through more complete reporting and documentation of OTC NSAID use in their EMR. Concerns were expressed about: keeping this information up-to-date, if the information would be used or (if used) evaluated by a qualified provider on their health care team, and mode (e-mail or telephone) and timeliness about how they would be informed about potential risks from their OTC NSAID use. Conclusions: Consistent with the Chronic Care Model, participants acknowledged that the proposed intervention would create productive interactions with their providers and likely improve their health outcomes. Their perspectives also yielded some unexpected insights (e.g. importance of timely updating of OTC NSAID use) and have resulted in modifications to the overall intervention design.