Hi, my name is Kate Lapane and I am a professor of epidemiology at the Virginia Commonwealth University in Richmond, Virginia. I’m a researcher who focuses on medication issues in older adults, and in particular in underserved populations. We believe that the patient should feel empowered to know that they can talk openly about their medication issues with their health care team members. This AHRQ-funded study focused on a comprehensive patient-centered approach to address medication management issues in older adult patients. Together with our research team of scientists, physicians, pharmacists, a medical anthropologist, health IT experts and a film producer, in Providence, Rhode Island and Richmond, Virgina. We looked at how to integrate patient-specific medication information from electronic health records into culturally and linguistically appropriate DVD and print materials. This bilingual multimedia intervention encourages patients to communicate openly with their clinicians and to improve their ability to take medications properly on their own at home. The DVDs address such topics as diabetes, heart failure, sleep issues, warfarin use, and we also had segments on general advocacy issues, empowering patients to talk to their physicians, how to fill a pill box, and tips for adherence. Our approach to developing this intervention was unique because we were trying to use a high-tech approach by integrating the education materials with electronic health records, but also a low tech approach because we were trying to reach underserved communities. So we used the low-tech approach. We went with developing DVDs that could be used with standard equipment that most people have: their TVs and a DVD player. We also wanted to use DVD format because some of the concepts that we’re trying to teach in the videos may take watching multiple times. And we thought the DVD concept would be an easy way for an older adult to share information about their conditions with family members and friends who are helping them so that they can help them adhere to their medications. The beauty of the DVD system is that our algorithms are written in a way that they can work with data streams, active medication records, from any data system. Including electronic medical records, electronic health records, electronic prescribing system. As long as these systems can output the data in text format, it can interface and create individualized DVDs for an older adult. Writing the algorithms was easy. We used SAS, and it was just a series of if-then statements. Based on the specific medications, it would pull off specific video segments related to whether or not they were on the medications. I’m a quantitative researcher, but I also know the limits of the data sources that I use to evaluate medication-related issues. So when I was assembling the team I realized that I wanted somebody who was an expert in qualitative research methods to help us reach out to the populations that I wanted to engage to help me understand more about what’s happening behind these numbers that we see and really to understand, what is it that we need to address? I’m Roberta Goldman. I am an anthropologist and professor in family medicine at Brown University. And I was involved in this project from the beginning through the end. So in the beginning we did what we call exploratory focus groups. Three with Spanish-speaking Latinos, four with non-Hispanic whites and four with non-Hispanic blacks. And, what we did was we took all the stories from the focus groups that seemed to be prevalent and made sure that that kind of issue was in all of the appropriate places throughout all of the modules. We wanted people to be able to see themselves in these videos, to be able to look at something and say, “Yeah, I’ve got that problem, ‘or’ I don’t have that problem but my sister has that problem,” Because just having informational videos where people are just told, “This is what you need to do, this is a dangerous thing to do.”, we didn’t think would be the most engaging way to get people to really feel that we’re talking to them. The other thing that I think is important for people to know about making this kind of thing, is that we’re writers not speakers. So our original scripts that we thought were terrific were not really speakable. When we first started working on the scripts, they were writing longer sentences, more complex words and when I read through the scripts I said, unfortunately it’s beautiful English but it won’t translate properly to the audience that we’re seeking here. We worked on revising the scripts so that they could be easily spoken by our on-camera narrators and by our talent and easily understandable for the audience. Probably the most important decision that we reached together as a team was the decision to produce both in spoken English and spoken Spanish. So to stay within the budget, we wrote all of the scripts first, translated everything into Spanish, and then ganged all of the production together on all six subject areas. One of the challenges of doing the videos both in spoken English and spoken Spanish is that Spanish is by its very nature longer than English by about 30 percent actually, so it means that when you edit the Spanish everything has to be longer. So part of what we needed to do when we were scripting it in Spanish was make sure that the phrasing that we used was understandable to the widest variety of people from different countries. In order to make the video as inclusive as possible, we recruited 55 people who represented different racial and ethnic groups, different hair types, different body shapes, different decades within the older adult range and male and female. So that really, hopefully, anybody who was in the study would be able to resonate with the kinds of images that they were seeing on the screen. We clearly were filling a gap. Folks, even if they’d had diabetes and heart failure for years, were learning things from these video that they did not know. We learned that older adults, they just assumed that all of their physicians communicated effectively with each other and that they all knew about all of the medications that each health care provider was prescribing because it’s all in the computer. So we understood that there was a miscommunication there about medications, so we wanted to reinforce in our videos that we need to know as their healthcare team and they need to know as the patient. So you’re working on the script? Yeah, we’re getting close. I wanted you to check a couple of things about… Patient-centered care focuses on empowering patients, activating them to really be in control of their diseases instead of their diseases being in control of them. So the patient-centered medical concept that we worked with was to use technology, in this case tailored DVDs, to augment the interactions that occur in the office setting. Our approach was to directly deal with the differences in culture and language related to medication adherence issues and some of the health disparities that we see in the care of chronic diseases. This approach may be useful for other researchers because patients are used to getting information on their TVs, and they get it for entertainment so why not get educational information about health problems in the same format. Overall, we learned that the patients were receptive to this intervention, they really enjoyed the educational materials, they watch them and that this avenue for educational materials for older adults and medication issues offers hope.