The first portion of this segment, How To Create and Use A Personal Medication Record, noted that several models of the Personal Medication Record (PMR) are available. Today, the focus is on the means by which one can assess the utility of the actual formats.

In my research for these posts on the PMR, I found far too many PMR candidates to provide even a representative sampling for readers, let alone an exhaustive review. I also discovered, however, that there are a few telltale signals that provide valuable insight into the design of the PMR and its potential fit with the user.

The Pen and Pencil PMR

The example from this category is the AARP-sponsored PMR depicted below (not actual size).¹

Note that the layout is logical, the print is clear, and content is easy to understand. Sufficient room is provided to write the information needed. The box on the first page titled “How to use this Guide” has helpful instructions, especially for those using the form for the first time. The reminder to list all medications is repeated on the second page. All the data cues ask for information that is either essential or of high probable utility. On the first page, “Other Physicians” and “My Medical Conditions” fall into the “not essential but likely useful” category as does the column headed “Start/Stop Dates” on the second page.

My criticisms are limited to a few minor points:

• The user’s phone number. I’m unconvinced of the benefit of including the user’s phone number although I can see the obvious value of an emergency contact. I may be overprotective of my telephone number but I’d prefer not entering any data that is not clearly needed. Were I using this form, I would adapt it by entering, as shown, “See ‘Emergency Contact’” in that space.
• “Last updated” location. I think this is especially important information and worry that it could be missed because it is placed in a box that otherwise has no data entry points. I suggest highlighting it in some manner as a visual cue.
• Page identification. This is a two (or more) page form. My experience is that multi-page forms are prone to separate into the constituent pages and attach themselves to another individual’s file or last month’s page one becomes paired with this month’s revised page 2. Consequently, I suggest that the pages be stapled together and that each page be labeled with the user’s name, the date of the last revision, and its page number. For the first page, only the page number must be added. As indicated, the name, date of last revision, and page number must all be added to the second page.

To be considered as a candidate for your PMR, other formats should at least meet the standard set by the AARP form, the quality of which is thrown into relief when it is compared with less thoughtfully constructed PMRs, such as the one page version shown below.

This Personal Medication Record, one notes, devotes more space to categorizing the type of drug allergies than to listing the medications. Knowing whether one is allergic to anesthesia or allergic to pain medication is, one could argue, more helpful to the doctor than the patient. I’m also not sure “Latex” is a medication or that the distinction among “Aspirin,” “Pain Medication,” and ”
Anti-inflammatory” is either clear or useful. In addition, the space allotted for the medications is insufficient for anyone without calligraphic skills. Finally, there is no “Last updated” cue.

The On-line PMR

When determining which on-line PMR is best for you, there are obvious points, such as a solid privacy policy, a program that works reliably and with reasonable speed when accessed from the computer(s) and internet provider(s) you will commonly use for this purpose, and cost which can easily be determined. Beyond that, however, the individual pros and cons become difficult to track.

Instead of considering such issues individually, I suggest you look at the orientation of the program’s design. My working hypothesis is that On-line PMRs can be divided into two groups: (1) those designed primarily for the benefit of the PMR user and (2) those designed for the convenience of the entity offering the PMR (e.g., a health insurance company).

Note: Typically, it is advantageous a PMR designed for the benefit of the user.

The comparisons that follow will illustrate this idea. PMR #1 is offered to any user at no cost and is apparently supported by product advertising on the same web site albeit not on the PMR itself. PMR #2 is one of those offered by an employer to its employees or byk an insurer to its clients and is available to those eligible at no charge.

The graphic below compares the lists of medication choices users of these two PMRs see on entering “Actos,” a medication used to control diabetes, into the user’s medication list.

The key point is that PMR #1 offers three choices, Actos in the three strengths in which it is sold: Actos 15 mg, Actos 30 mg, and Actos 45 mg., while PMR #2 offers over 50 choices (the screen shot above shows only a portion of the total list) the same medication offered in the same three strengths. Some of the additional choices in PMR #2 arise from some entries featuring the generic name as well as the brand name and some that don’t, but the major factor is that each Actos item is associated with a different NDC code.² My assumption is that the correct NDC is somehow useful to the PMR provider although that seems suspect given that patients do not routinely know NDC numbers and have no way of determining which of the several Actos 30 mg selections one should choose and if, indeed, if makes any difference. At best, it’s confusing.

A similar problem arises if the user wants more information regarding a medication. A strength of on-line PMRs compared to paper and pencil PMRs is the relative ease of obtaining that information. Both PMR #1 and PMR #2 offer buttons that lead to the following screens for Actos:

PMR #1 takes the user to a web site about the medication prepared by the manufacturer. PMR #2 produces a Medline search list. If the PMR were used only by healthcare professionals and knowledgeable patients, I would agree that a Medline search might be the superior offering. Those less familiar with medical terms, however, looking for only basic information such as side-effects, could be overwhelmed, confused, and intimidated by the search list, especially since it preponderantly uses the less common scientific names. One can hardly fault the use of Medline but providing a patient with a single, clear site with the information about side-effects, dosages, etc seems to me the more efficient and effective tactic.

On a related note, PMR #1 offers schedule choices based on time of day (e.g., 7 AM) while PMR #2 offers the Latin abbreviations such as qid, bid, prn, etc. It seems clear which is more easily comprehensible to the naive user. Similarly, PMR #1 provides recognizable graphic representations of the actual pill or capsule, a valuable tool if, for example, the patient is mistakenly given the incorrect medication, or, less dramatically, uses the PMR to make sure the right pill is deposited into the right section of the pillbox; PMR #2 doesn’t offer realistic illustrations.

Perhaps most telling is the view of the total list afforded the PMR user.

The standard view of PMR #1 is the display of all the medications, including name, dose, illustration, and schedule of doses. The standard view of PMR #2 is a similar list of medication names and doses but the schedule for taking those doses is revealed for only one selected medication at a time. Again, PMR #1 offers more utility to the patient.

Also check for other features that may be useful for you. While is a technological trifle, some PMRs offer “wallet sized” PMRs or at least lines for folding large sheets into more manageable sizes.

I find this helpful; others, no doubt, will see it as unnecessary.

As is true of many PMRs, both of these specimens offer refill reminders.

PMR #1 does not have a method within its program of sending the PMR to others or allowing others to access the medication listing. PMR #2, on the other hand, does offer this important feature.

Users can, in fact, allow specified others to access the information on-line and email or fax the PMR to others. Moreover, the access can be limited to certain information, excluding other data, and users can be allowed read-only access or permission to add to the file. That said, the directions for encrypting and decrypting the data are so complex and cumbersome that I was daunted before learning the entire process although I’ve used encrypting software and services on a daily basis for several years. It would require, I believe, significant dedication on the part of any non-geek to actually use the procedure.

The Future

There is an altogether laudable movement to standardize the Personal Medication Record (and the Personal Health Record). When that takes place, this sort of advice will, one hopes, be moot. Given the medical, ethical, and political issues involved, however, reaching that goal in the short term is improbable. In any case a Personal Medication Record is too important to be deferred for a few days, let alone a few months or, more likely, a few years.

So, read about PMRs, make your choices about what is and isn’t important, and try out a form or two to see what fits. Then create your PMR and use it.

Footnotes

1. While the AARP offering is, in my judgment, the best of the lot, its use here should not be considered a recommendation. [back]
2. According to the FDA web site, the NDC is the National Drug Code, a unique 10-digit, 3-segment number assigned to each medication listed under Section 510 of the U.S. Federal Food, Drug, and Cosmetic Act. The number identifies the labeler or vendor, product, and trade package size. The first segment, the labeler code, is assigned by the Food and Drug Administration (FDA). A labeler is any firm that manufactures, repacks or distributes a drug product. The second segment, the product code, identifies a specific strength, dosage form, and formulation for a particular firm. The third segment, the package code identifies package sizes. [back]

Related Posts:

• Test-Driving The Personal Medication Record
• How To Create and Use A Personal Medication Record
• Everyone Needs A Personal Medication Record
• Compiling The Personal Medication Record
• Another Reason The Personal Medication Record Is Essential