Available with the v3.5.5 release of Chronic Pain Tracker, you now have the ability to define a Start Date and End Date for each custom Medication item in the Medication Tracker. Although this feature is optional, we do encourage our users to take advantage of it where applicable.
The feature has been added for two key reasons. First, it helps avoid mistakes at the time of entry creation, and second, it improves the accuracy of medication usage reporting. Let’s take a look at how to enable this feature and also how these benefits are achieved.
Defining Medication Usage Dates
To apply a Start or End Usage Date to your Medication items, you’ll need to open the Tracker List editing table for the Medication Tracker object. You can access this table either by (1) Going to the Settings tab, selecting Diary Preferences -> Medication Taken -> Edit Medication List, OR (2) Starting a new Diary Entry, adding the Medication Taken tracker to the entry, and selecting the “Edit Table Entries” from the medication table.
Once you have opened the Medication List, you can select the medication you wish to edit. In the example shown here, we’re going to edit the usage dates for “Dilaudid 4mg”. Once selected, you will see the details for this medication item. By default the Start/End dates will show as “Not Defined”.
|Medication Tracker List||Medication Item Showing Start/End Dates as Not Defined|
By tapping on the Start Date row, you will be presented with options for setting the date value. As you can see in this image, you have the option to (1) Manually Set the Date, (2) Automatically Set the Date, (3) Clear the Date, or (4) Cancel the Change. If you choose to Manually Set the Date, you will be presented with a Date Picker as shown in the second image below. Adjust the Month, Day & Year values to the appropriate date.
If you choose to use the Automatic option, the app will determine the Start/End Usage Date by looking up the First/Last time you used that particular medication and use that date as the new value. This usually will be sufficient, so we recommend using the automatic selection option first, and if necessary using the manual option to fine tune the date value.
If you set a date incorrectly (eg. setting an End Usage Date for the medication, but you are actually still taking it), you can use the Clear the Date option to reset the date to the “Not Defined” value.
|Options for Setting the Start/End Date Values||Using the Date Picker to Set a Start Date Value|
Once you’ve set the Start/End dates as desired, you will tap on the Done button in the upper left corner and then you’ll need to save the changes (green checkmark in upper right) to the Medication List.
For CPT users that have Device-to-Device Sync Enabled
We have identified a bug with v3.5.5 that prevents the proper saving of Tracker List changes when device-to-device sync is enabled. Although the changes appear to be saved, if you re-open the tracker list item, you’ll see the same previous values in place for that item. This bug is being addressed in the next update, but until then, you can do the following to avoid this problem.
Before you make any Tracker List changes, go to Settings tab -> Cloud Services -> Device Sync Services. Scroll to the bottom of the screen and tap on Turn Off Sync Services for Device to disabled the sync processing. Then you can make your Tracker List changes. Once those are complete, you can re-enable the Sync services. We do suggest going through the process of Uploading your Master DB to the cloud repository and Downloading the Master DB to your secondary devices after this step to ensure that all devices are starting from the same synchronized baseline.
Improved Medication Input with Usage Dates
One of the benefits of assigning usage dates to your medication items is that CPT can now help you avoid errors when creating new diary entries. This is done by giving you a warning message if you try to enter the usage of a medication for a diary entry that is before or after the associated usage date range.
For example, consider the situation where you have indicated that your “Dilaudid 4mg” medication was used from Nov 22, 2011 to Jan 10, 2014 via the new Start/End Dates. You then begin a new diary entry input for Feb 3, 2014. If you select the “Dilaudid 4mg” during that entry, you will receive a warning like the one shown below. This warning indicates that you are trying to indicate medication usage outside the defined timeframe.
|Warning Shown During Diary Entry When Selecting a Medication Beyond Its Availability Date Range|
Improved Medication Reporting with Usage Dates
The more significant benefit of setting the usage dates comes when we look at CPT’s reporting features – specifically the Medication Tracker Summary Report. There are 4 standard graphs created per medication item in the current Summary Report format. Of these 4, the first graph, “Daily Medication Qty Totals per Day”, is the one where this change is most obvious.
The impact comes from the way we evaluate usage of the medication item. This is most easily explained by using the example of a breakthrough pain medication that is used a variable number of times per day – as needed for pain. There are some days where the pain is high and you may use the medication 3 or 4 times; maybe other days it will be moderate and it’s used only once or twice. Still other days, the good days, and you may not use the medication at all. It’s this last situation where the usage dates come into play.
|Graph 1 – Daily Qty Totals when Start/End Dates are Not Defined||Graph 2 – Daily Qty Total when Start/End Defined|
Graph 1 above shows a situation where usage dates are not defined for the “Dilaudid 4mg” medication item. You can see that there is consistent usage of the medication for the first half of the period, but then it drops to zero for each day. You can also see that there is a Medication Change milestone indicator at the point where the usage stops.
Looking at this you could assume that this was a situation where you were continuing to have the Dilaudid 4mg available for use but didn’t need it once you added some other medication to your treatment strategy (Scenario A). Or, perhaps this was a situation where you were using Dilaudid 4mg for the first part of the period, but then stopped using it in favor of a different medication (Scenario B). Although these situations are similar, they are unique and you’d probably want to report on them differently.
Graph 1 matches well to Scenario A since we continue to plot data points for the days after the medication change, and the moving average plot (green line) continues for the full width of the plot accounting for the reduced usage levels in the period after the medication change. The overall period average qty used indicated by the horizontal line labeled 1.1 tablets per day also reflects the average usage of Dilaudid 4mg during the period.
But for Scenario B when the usage of Dilaudid 4mg was discontinued after Jan 10, we would prefer a different view of the data, and that’s where Graph 2 is relevant. Here, we have the Jan 10, 2014 End Date defined in the Medication item. So now you can see that the Daily Qty data points past Jan 10 are shown, but they are grayed out indicating that the medication was not available during those days. You can also see that the moving average plot stops at the Jan 10 date since this was the last day the medication was available for use. And finally, the overall period average qty used is calculated only for the days when the medication was available and shows a 2.3 tablet per day use of the Dilaudid.
We believe the inclusion of Start/End Dates for the Medication items will allow you to generate more accurate summary data like those shown here. Both scenarios are realistic and therefore we saw a need to enable both to be reflected in the summary analysis and graphs. Enabling the definition of Start/End Dates now gives you the ability to deal with both of those situations.