Diabetes affects 12 % of adult Americans and is a primary contributor to cardiovascular disease, renal failure, non-traumatic amputation, and blindness. DM (diabetes mellitus) can be treated through effective management of medications to lower blood glucose, blood pressure, and cholesterol; however, only 50% of patients take medications as prescribed. BIG-DASH is testing a new approach to tackle health literacy barriers and facilitate adherence with complex medication regimens, thus improving glycemic control and blood pressure for the >30% of Duke Medicine patients with diabetes and uncontrolled blood pressure or glucose.
We propose to: 1) identify a population of patients with DM and uncontrolled hypertension or DM and uncontrolled glucose in the adult Endocrinology clinics using the newly created Endocrine Healthy Planet Dashboard integrated into Maestro Care; 2) invite a cohort of this population with MyChart patient portal access (80% of population) to participate in a 6 month, app-driven patient support initiative; and 3) implement a workflow change to accommodate integration of the provider dashboard with the EHR-integrated app (Duke Pillbox), for real-time feedback to both patients and providers on medication use and blood pressure control.
Duke Pillbox – Epic Integrated Medication Adherence Mobile App
The Duke PillBox is a patient-centered, skill-based interactive learning tool designed to improve skills for medication management and patient-provider communication for medication reconciliation and medication adherence. The app teaches patients skills required to identify and organize pills in a daily and weekly med-dosing schedule. The design overcomes health literacy barriers and optimizes patient opportunities to communicate questions, concerns and misunderstandings regarding medication management with providers. Developed by DUHS in collaboration with MedAppTech, Duke Pillbox improves self-management through patient learning, communication and user-satisfaction outcomes in hospital, clinic and home settings. The Duke Pillbox solution captures and manages data from patient interactions in a continuous, reportable feedback loop to improve 1) communication for medication changes; 2) patient-reported side effects; 3) education for medication misses; 4) health literacy for medication management; 5) data capture for medication management and adherence over time.
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