Transcript Style B 24 by 48 wide - Stritch School of Medicine

1,2
PharmD ,
3
MD ,
1
Bruce I. Gaynes, OD,
Tatyana Spektor
Nicole Nicolic, BS
1.Loyola University Chicago, Stritch School of Medicine, Department of Ophthalmology, Maywood, IL
2. Edward Hines Jr. VA Medical Center, Hines IL
3. Rush University Medical Center, Department of Ophthalmology, Chicago, IL
4160-A0148
Introduction
ScripTalk® (ST) is a text-to-speech
prescription medication label reader
designed to help the visually impaired
prevent medication administration errors in
the home environment. Our study focuses
on characterizing the users of ScripTalk®,
highlighting risk factors for adverse events
and addressing efficacy of the label reader
technology vs. use of common pill-box
organizers in terms of rate of
hospitalization
Methods
A retrospective cohort study was
performed examining high-risk chronically ill
patients enrolled into the ScripTalk®
program from 2006-2011 at the Hines
Veterans Affairs Hospital. The degree of
visual impairment, co-morbidities, use of a
pillbox, reported missed medications, and
hospitalizations were selected co-variants
for analyses.
Study subjects were identified from the
864 patients at Hines Veterans Affairs
Hospital who were enrolled into the ST
program from 2006-2011 following discharge
from the Hines VA Blind Rehabilitation
Center. From this group, 84 patients were
identified as being high-risk with multiple
significant comorbidities. Age of the study
cohort ranged from 49-97 years.
Corresponding author: [email protected]
Author disclosures: none
The support of the Richard A Perritt
Charitable Foundation is acknowledged
Methods
Participants were identified as being
high-risk patients if it was deemed their
medication regimen and comorbidities posed
a significant hazard in the event of
medication mis-adventure. The criteria used
to determine this risk included: having at
least 1 prescribed medication with a low
therapeutic index, being treated for
congestive heart failure, taking greater than 4
anti-hypertensive medications and/ or having
multiple significant risk factors for
cardiovascular disease. Prescription
medications with a low therapeutic index
included warfarin, anti-epileptics, and antiarrhythmic medications. The presence of
insulin-dependent diabetes mellitus, coronary
artery disease and/or having a history
of previous myocardial infarction or cerebral
vascular accident were considered to be
significant comorbidities.
Whether or not a patient missed
medication administration was determined by
self-reporting.
Causes for visual impairment are shown
in Figure 1 below:
Figure 1.Causes of visual impairment
Results
Overall, 57 patients (67.9%) reported
regular use of a pillbox, 21 (25%)
patients denied pillbox use. With respect
to use of other assistive devices aside
from ST or a pill box, 54.8% reported use
of at least 1 other device, the most
common being a hand held magnifier.
Of the subjects using pillboxes, 61.4%
filled them independently, 38.6% required
the assistance of another person.
Of the multivariate predictors of
repeat hospital admission, including:
age, degree and duration of vision loss,
and whether or not the subject was
reminded to take their medication, the
degree of vision loss was the strongest
risk factor for increased number of
hospital admissions. The rate of
hospitalization by vision loss is shown in
Figure 2. The influence of pill box use on
annual hospitalization rate and total per
patient hospitalization is shown in Figure
3. At the conclusion of the study interval
2 of the 84 subjects had expired and only
13% of the cohort continued to order
medications with ST enabled Rx labels.
Figure 2. Hospitalization rate and visual
function
Figure 3. Annual hospitalization rate and total
hospitalizations
per patient
Conclusion
With respect to modifiable risk factors, the use of a
pillbox appears to be a relatively simple and
effective addition to assist visual impaired patients
in appropriate home medication use. The benefit of
a prescription label reader in reducing
hospitalization rate among individuals is less
apparent in the constraints of the current study
design.