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Saffer H, Cunningham A. Comparing "Meaningful Use" of Health Information Technology in Pennsylvania: Electronic Prescription Rates of Metropolitan and Rural Counties. Popul Health Manag 2024; 27:114-119. [PMID: 38411668 DOI: 10.1089/pop.2023.0258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024] Open
Abstract
The Health Information Technology for Economic and Clinical Health Act incentivized the adoption of electronic health records (EHRs). Health systems looked to leverage technology to assist in serving populations in health professional shortage areas. Qualitative research points to EHR usability as a source of health inequities in rural settings, making the challenges of EHR usage a subject of interest. Pennsylvania offers a model for investigating rural health infrastructure with it having the third largest rural population in the United States. This study analyzed the adoption of Electronic Prescribing in the 67 Pennsylvania (PA) counties. Physician adoption and usage data for PA and the United States were compared using a t-test to establish a basis for comparison. PA counties were categorized using the United States Department of Agriculture (USDA)'s Rural-Urban Commuting Areas (RUCAs) system. Surescript use percentages were plotted against the RUCA scores of each PA county to create a polynomial regression model. PA office-based physicians, on average, utilize e-prescription tools at the same rate as the national average with 59% of practices utilizing Surescripts as of 2013. There was no significant correlation between Surescript usage and the rural/urban classification of counties in Pennsylvania (R-squared value of 0.06). Pennsylvania was able to adopt health information technology (HIT) infrastructure at the same rate as the national average. Rural and metropolitan definitions do not correlate to meaningful use of HIT, thus usability of HIT cannot be tied to health outcomes. Future studies looking at specific forms of HIT and their ability to decrease the burden of administrative work for clinicians.
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Affiliation(s)
- Heath Saffer
- Department of Family and Community Medicine, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Amy Cunningham
- Department of Family and Community Medicine, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
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Abera SM, O’Donnell C, Salahuddin T, Prabhu K, Simons CE, Ho PM, Waldo SW, Doll JA. Assessment of Medication Adherence Using Pharmacy Data Before and After Percutaneous Coronary Intervention. Patient Prefer Adherence 2023; 17:2789-2795. [PMID: 37942121 PMCID: PMC10629403 DOI: 10.2147/ppa.s431183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/29/2023] [Indexed: 11/10/2023] Open
Abstract
Objective Adherence to anti-platelet medications is critical following coronary stenting, but prior studies indicate that clinician assessment and patient self-assessment of adherence are poorly correlated with future medication-taking behavior. We therefore sought to determine if integrated pharmacy data can be used to identify patients at high risk of non-adherence after percutaneous coronary interventions (PCI). Methods Using Veteran Affairs (VA) Clinical Assessment, Reporting, and Tracking (CART) data linked with pharmacy records, we assessed adherence to cardiovascular medications from 2012 to 2018. Adherence was defined as the proportion of days covered (PDC) ≥ 0.80. We assessed the association of pre-PCI adherence with post-PCI adherence to P2Y12 inhibitors and clinical outcomes using logistic regression and Cox proportional hazard models, respectively. Results Among 56,357 patients, 66.0% filled at least 1 cardiovascular medication within VA for the year prior to PCI and were evaluable for adherence. Pre-PCI non-adherence was 20.7%, and non-adherent patients were more likely to be younger and present non-electively. Non-adherent patients were less likely to adhere to P2Y12 inhibitor therapy after PCI (Adjusted OR 0.45 C.I. 0.41-0.46), compared with adherent patients, and had a higher adjusted risk of mortality (HR 1.17 C.I. 1.03-1.33). Conclusion Adherence to cardiovascular medications prior to PCI can be assessed for most patients using pharmacy data, and past adherence is associated with future adherence and mortality after PCI. Use of integrated pharmacy data to identify high-risk patients could improve outcomes and cost-effectiveness of adherence interventions.
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Affiliation(s)
- Seifu M Abera
- Section of Cardiology, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Colin O’Donnell
- Department of Veterans Affairs Clinical Assessment, Reporting, and Tracking Program, VHA Office of Quality and Patient Safety, Washington, DC, USA
| | - Taufiq Salahuddin
- Section of Cardiology, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | | | - Carol E Simons
- Section of Cardiology, VA Puget Sound Health Care System, Seattle, WA, USA
| | - P Michael Ho
- Rocky Mountain Regional VA Medical Center, Aurora, CO, USA
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Stephen W Waldo
- Department of Veterans Affairs Clinical Assessment, Reporting, and Tracking Program, VHA Office of Quality and Patient Safety, Washington, DC, USA
- Rocky Mountain Regional VA Medical Center, Aurora, CO, USA
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jacob A Doll
- Section of Cardiology, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Veterans Affairs Clinical Assessment, Reporting, and Tracking Program, VHA Office of Quality and Patient Safety, Washington, DC, USA
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Dietrich F, Zeller A, Allemann S, Arnet I. Development and acceptance of a new adherence monitoring package to identify non-adherent patients with polypharmacy in primary care: a feasibility study. BMJ Open Qual 2023; 12:bmjoq-2022-002155. [PMID: 36849193 PMCID: PMC9972443 DOI: 10.1136/bmjoq-2022-002155] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/11/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Adherence to pharmacotherapy is crucial to prevent symptom deterioration in chronic diseases. However, non-adherence to chronic treatments is prevalent, especially in polypharmacy. Practical tools to assess adherence to polypharmacy in primary care are missing. AIMS We aimed to develop an Adherence Monitoring Package (AMoPac) for general practitioners (GPs) to identify patient non-adherence. We tested the feasibility and acceptance of AMoPac in the primary healthcare setting. METHODS AMoPac was developed based on peer-reviewed literature. It consists in (1) electronic monitoring of patients' medication intakes for 4 weeks, (2) receiving feedback on intake behaviour by the pharmacist and (3) generating an adherence report to communicate to the GPs. A feasibility study was conducted with heart failure patients. GPs' acceptance of AMoPac was explored with semistructured interviews. Electronic transmission of the reports into the GP's electronic health record along with laboratory reports stating N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels was analysed. RESULTS We developed AMoPac and tested its feasibility with six GPs and seven heart failure patients. GPs were satisfied with the adherence report including the pharmaceutical-clinical recommendations. Integrated transmission of adherence reports to GPs was not feasible due to technical incompatibilities. Mean taking adherence was 86.4%±12.8% and three patients had low correct dosing-days (69%, 38% and 36%, respectively). NT-proBNP ranged from 102 to 8561 pg/mL and four patients had elevated values (>1000 pg/mL). CONCLUSION AMoPac is feasible in the primary healthcare setting, excluding the integrated transmission of adherence reports to GPs. The procedure was highly accepted by GPs and patients. AMoPac fills a gap by combining clinical values with adherence data, and therefore, delivers a multifaceted picture of the patient's behaviour. In case of unmet adherence, our tool might facilitate the selection of patient-centred approaches to optimise pharmacological therapies in chronic heart failure patients. TRIAL REGISTRATION NUMBER NCT04326101.
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Affiliation(s)
- Fine Dietrich
- Pharmaceutical Care Research Group, Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Andreas Zeller
- Centre for Primary Health Care, University Hospital Basel, Liestal, Switzerland
| | - Samuel Allemann
- Pharmaceutical Care Research Group, Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Isabelle Arnet
- Pharmaceutical Care Research Group, Pharmaceutical Sciences, University of Basel, Basel, Switzerland
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Sybil D, Krishna M, Shrivastava PK, Singh S, Khan I. Innovative App (ExoDont) and Other Conventional Methods to Improve Patient Compliance After Minor Oral Surgical Procedures: Pilot, Nonrandomized, and Prospective Comparative Study. JMIR Perioper Med 2022; 5:e35997. [PMID: 35763332 PMCID: PMC9277528 DOI: 10.2196/35997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/26/2022] [Accepted: 06/21/2022] [Indexed: 11/27/2022] Open
Abstract
Background Postoperative care is influenced by various factors such as compliance, comprehension, retention of instructions, and other unaccounted elements. It is imperative that patients adhere to the instructions and prescribed regimen for smooth and placid healing. ExoDont, an Android-based mobile health app, was designed to ensure a smooth postoperative period for patients after a dental extraction. Besides providing postoperative instructions at defined intervals, the app also sends drug reminders as an added advantage over other available, conventional methods. Objective The aim of this study was to compare the compliance rate of individuals with respect to the prescribed regimen and postoperative instructions. Additionally, we aimed to assess any changes in the postoperative complication rate of patients assigned to 3 categories: the verbal, verbal plus written, and ExoDont app-based delivery groups. Methods We conducted a pilot, nonrandomized, and prospective comparative study in which patients after tooth extraction were assigned to 3 groups—verbal (Group A), verbal plus written (Group B), and ExoDont app-based delivery (Group C)—based on the eligibility criteria, and a 1-week follow-up was planned to obtain the responses regarding compliance and postoperative complications from the participants. Results In total, 90 patients were recruited and equally divided into 3 groups. Compliance to prescribed drug was found to be the highest in Group C, where of the 30 participants, 25 (83%) and 28 (93%) followed the entire course of antibiotics and analgesics, respectively. For postoperative instructions, higher compliance was observed in Group C in relation to compliance to diet restrictions (P=.001), not rinsing for 24 hours (P<.001), and warm saline rinses after 24 hours (P=.001). However, the difference was not significant for smoking restrictions (P=.07) and avoiding alcohol (P=.16). Moreover, the difference in postoperative complication rate was not statistically significant among the 3 groups (P=.31). Conclusions As evident from the results, it is anticipated that the ExoDont app will be helpful in circumventing the unaccounted possibilities of missing the prescribed dosage and postoperative instructions and ensuring the smooth recovery of patients after dental extraction. However, future studies are required to establish this app-based method of delivery of postoperative instructions as a viable option in routine clinical practice.
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Affiliation(s)
- Deborah Sybil
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Jamia Millia Islamia, Delhi, India
| | | | | | - Shradha Singh
- Faculty of Dentistry, Jamia Millia Islamia, Delhi, India
| | - Imran Khan
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Jamia Millia Islamia, Delhi, India
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Millares Martin P. Reducing medication errors still needs a health informatics solution in clinical practice. HEALTH AND TECHNOLOGY 2022. [DOI: 10.1007/s12553-022-00644-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Perera UT, Heeney C, Sheikh A. Policy parameters for optimising hospital ePrescribing: An exploratory literature review of selected countries of the Organisation for Economic Co-operation and Development. Digit Health 2022; 8:20552076221085074. [PMID: 35340903 PMCID: PMC8941697 DOI: 10.1177/20552076221085074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 02/16/2022] [Indexed: 11/16/2022] Open
Abstract
Objective Electronic prescribing systems offer considerable opportunities to enhance
the safety, effectiveness and efficiency of prescribing and medicines
management decisions but, despite considerable investments in health IT
infrastructure and healthcare professional training, realising these
benefits continues to prove challenging. How systems are customised and
configured to achieve optimal functionality is an increasing focus for
policymakers. We sought to develop an overview of the policy landscape
currently supporting optimisation of hospital ePrescribing systems in
economically developed countries with a view to deriving lessons for the
United Kingdom (UK). Methods We conducted a review of research literature and policy documents pertaining
to optimisation of ePrescribing within hospitals across Organisation for
Economic Co-operation and Development (OECD) countries on Embase, Medline,
National Institute for Health (NIH), Google Scholar databases from 2010 to
2020 and the websites of organisations with international and national
health policy interests in digital health and ePrescribing. We designed a
typology of policies targeting optimisation of ePrescribing systems that
provides an overview of evidence relating to the level at which policy is
set, the aims and the barriers encountered in enacting these policies. Results Our database searches retrieved 11 relevant articles and other web resources
mainly from North America and Western Europe. We identified very few
countries with a national level strategy for optimisation of ePrescribing in
hospitals. There were hotspots of digital maturity in relation to
ePrescribing at institutional, specialisation, regional and national levels
in the US and Europe. We noted that such countries with digital maturity
fostered innovations such as patient involvement. Conclusions We found that, whilst helpful to achieve certain aims, coordinated strategies
within and across countries for optimisation of ePrescribing systems are
rare, even in countries with well-established ePrescribing and digital
health infrastructures. There is at present little policy focus on
maximising the utility of ePrescribing systems.
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Affiliation(s)
- Uditha T Perera
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK
| | - Catherine Heeney
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK
| | - Aziz Sheikh
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK
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Krishna M, Sybil D, Shrivastava PK, Premchandani S, Kumar H, Kumar P. An Innovative App (ExoDont) for Postoperative Care of Patients After Tooth Extraction: Prototype Development and Testing Study. JMIR Perioper Med 2021; 4:e31852. [PMID: 34982720 PMCID: PMC8760618 DOI: 10.2196/31852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/07/2021] [Accepted: 12/15/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The postoperative period is crucial for the initiation of healing and prevention of complications after any surgical procedure. Due to factors such as poor compliance, comprehension, and retention of instructions, and other unaccounted factors, the objectives of postoperative care are not always achieved. Therefore, an Android-based mobile health app (ExoDont) was developed to ensure a smooth postoperative period for patients after a dental extraction. The ExoDont app delivers reminders for postoperative instructions and drug intake at defined intervals, thus fostering self-reliance among patients in taking their prescribed dose of medication. OBJECTIVE The aim of this study is to design, develop, and validate ExoDont, an innovative app for improved adherence to postoperative instructions after tooth extraction. METHODS A postoperative treatment protocol was developed by a team of oral and maxillofacial surgeons and general dentists, following which the clinical and technological requirements of the app were determined along with the software engineers, graphic designers, and applications architect in the team. ExoDont was developed to provide timely reminders for medication and postoperative care. The app was field tested and validated using the User Version of the Mobile Application Rating Scale. RESULTS The ExoDont software design was divided into a 3-level architecture comprising a user interface application, logical layer, and database layer. The software architecture consists of an Android-based ExoDont app for patients and a web version of the admin panel. The testing and validation of the ExoDont app revealed that Perceived Impact received the highest mean score of all rated components (mean 4.6, SD 0.5), while Engagement received the lowest mean score (mean 3.5, SD 0.8). CONCLUSIONS The testing and validation of the app support its usability and functionality, as well as its impact on users. The ExoDont app has been designed, keeping the welfare of patients in view, in a user-friendly manner that will help patients adhere to the prescribed drug regimen and ensure easy and efficient dissemination of postoperative instructions. It could play an instrumental role in fostering compliance among patients and significantly decrease the complication rate following dental extractions.
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Affiliation(s)
| | - Deborah Sybil
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India
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Roodenrijs NMT, van der Goes MC, Welsing PMJ, van Oorschot EPC, Nikiphorou E, Nijhof NC, Tekstra J, Lafeber FPJG, Jacobs JWG, van Laar JM, Geenen R. Non-adherence in difficult-to-treat rheumatoid arthritis from the perspectives of patients and rheumatologists: a concept mapping study. Rheumatology (Oxford) 2021; 60:5105-5116. [PMID: 33560301 DOI: 10.1093/rheumatology/keab130] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/27/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Treatment non-adherence is more frequent among difficult-to-treat (D2T) than among non-D2T RA patients. Perceptions of non-adherence may differ. We aimed to thematically structure and prioritize barriers to (i.e. causes and reasons for non-adherence) and facilitators of optimal adherence from the patients' and rheumatologists' perspectives. METHODS Patients' perceptions were identified in semi-structured in-depth interviews. Experts selected representative statements regarding 40 barriers and 40 facilitators. Twenty D2T and 20 non-D2T RA patients sorted these statements during two card-sorting tasks: first, by order of content similarity and, second, content applicability. Additionally, 20 rheumatologists sorted the statements by order of content applicability to the general RA population. The similarity sorting was used as input for hierarchical cluster analysis. The applicability sorting was analysed using descriptive statistics, prioritized and the results compared between D2T RA patients, non-D2T RA patients and rheumatologists. RESULTS Nine clusters of barriers were identified, related to the healthcare system, treatment safety/efficacy, treatment regimen and patient behaviour. D2T RA patients prioritized adverse events and doubts about effectiveness as the most important barriers. Doubts about effectiveness were more important to D2T than to non-D2T RA patients (P = 0.02). Seven clusters of facilitators were identified, related to the healthcare system and directly to the patient. All RA patients and rheumatologists prioritized a good relationship with the healthcare professional and treatment information as the most helpful facilitators. CONCLUSIONS D2T RA patients, non-D2T RA patients and rheumatologists prioritized perceptions of non-adherence largely similarly. The structured overviews of barriers and facilitators provided in this study may guide improvement of adherence.
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Affiliation(s)
- Nadia M T Roodenrijs
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht
| | - Marlies C van der Goes
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht.,Department of Rheumatology, Meander Medical Center, Amersfoort, the Netherlands
| | - Paco M J Welsing
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht
| | - Eline P C van Oorschot
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King's College London and Department of Rheumatology, King's College Hospital, London, UK
| | - Nienke C Nijhof
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht
| | - Janneke Tekstra
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht
| | - Floris P J G Lafeber
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht
| | - Johannes W G Jacobs
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht
| | - Jacob M van Laar
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht
| | - Rinie Geenen
- Department of Psychology, Utrecht University, Utrecht, the Netherlands
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Dietrich F, Zeller A, Haag M, Hersberger KE, Arnet I. Communicating Electronic Adherence Data to Physicians-Consensus-Based Development of a Compact Reporting Form. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910264. [PMID: 34639562 PMCID: PMC8507897 DOI: 10.3390/ijerph181910264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/17/2021] [Accepted: 09/27/2021] [Indexed: 11/16/2022]
Abstract
Information on medication adherence is missing in patient files, although it might be helpful to optimize treatment. An adherence report that presents data from electronic adherence monitoring and provides recommendations regarding pharmacological treatment could close this gap. We aimed to develop an adherence reporting form that combines suitable calculations and graphical representations to facilitate the physicians’ interpretation of (non-)adherence. Two consensus development panels were conducted. First, pharmacists with expertise in adherence monitoring debated the items needed to calculate and illustrate electronic adherence data. Second, physicians discussed the items they would need for an adherence report and were encouraged to propose new items. Preference was indicated by raising a green or red card. Voting was repeated until consensus was obtained. Third, first drafts of the adherence reporting form were created by two pharmacists. Seven pharmacists agreed on four metrics to express medication adherence and three graphical representations. Five physicians approved the four metrics and rated the dot chart as the most useful illustration for judging the patient’s adherence patterns. Additionally, they required a clinical–pharmaceutical evaluation of the adherence estimates considering drug-related properties. We developed an adherence reporting form for the first time in a compact format and based on the recommendations of experts. In addition, we considered the preferences of physicians, who appreciated the clarity of the reporting form.
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Affiliation(s)
- Fine Dietrich
- Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, Petersplatz 14, P.O. Box 2148, 4001 Basel, Switzerland; (M.H.); (K.E.H.); (I.A.)
- Correspondence: ; Tel.: +41-61-207-15-29
| | - Andreas Zeller
- Centre for Primary Health Care, University of Basel, Rheinstrasse 26, 4410 Liestal, Switzerland;
| | - Melanie Haag
- Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, Petersplatz 14, P.O. Box 2148, 4001 Basel, Switzerland; (M.H.); (K.E.H.); (I.A.)
| | - Kurt E. Hersberger
- Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, Petersplatz 14, P.O. Box 2148, 4001 Basel, Switzerland; (M.H.); (K.E.H.); (I.A.)
| | - Isabelle Arnet
- Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, Petersplatz 14, P.O. Box 2148, 4001 Basel, Switzerland; (M.H.); (K.E.H.); (I.A.)
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Scheibner J, Sleigh J, Ienca M, Vayena E. Benefits, challenges, and contributors to success for national eHealth systems implementation: a scoping review. J Am Med Inform Assoc 2021; 28:2039-2049. [PMID: 34151990 DOI: 10.1093/jamia/ocab096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/27/2021] [Accepted: 05/21/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Our scoping review aims to assess what legal, ethical, and socio-technical factors contribute to or inhibit the success of national eHealth system implementations. In addition, our review seeks to describe the characteristics and benefits of eHealth systems. MATERIALS AND METHODS We conducted a scoping review of literature published in English between January 2000 and 2020 using a keyword search on 5 databases: PubMed, Scopus, Web of Science, IEEEXplore, and ProQuest. After removal of duplicates, abstract screening, and full-text filtering, 86 articles were included from 8276 search results. RESULTS We identified 17 stakeholder groups, 6 eHealth Systems areas, and 15 types of legal regimes and standards. In-depth textual analysis revealed challenges mainly in implementation, followed by ethico-legal and data-related aspects. Key factors influencing success include promoting trust of the system, ensuring wider acceptance among users, reconciling the system with legal requirements, and ensuring an adaptable technical platform. DISCUSSION Results revealed support for decentralized implementations because they carry less implementation and engagement challenges than centralized ones. Simultaneously, due to decentralized systems' interoperability issues, federated implementations (with a set of national standards) might be preferable. CONCLUSION This study identifies the primary socio-technical, legal, and ethical factors that challenge and contribute to the success of eHealth system implementations. This study also describes the complexities and characteristics of existing eHealth implementation programs, and suggests guidance for resolving the identified challenges.
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Affiliation(s)
- James Scheibner
- Department of Health Sciences and Technology, Health Ethics and Policy Laboratory, ETH Zürich, Zürich, Switzerland.,College of Business, Government and Law, Flinders University, Adelaide, Australia
| | - Joanna Sleigh
- Department of Health Sciences and Technology, Health Ethics and Policy Laboratory, ETH Zürich, Zürich, Switzerland
| | - Marcello Ienca
- Department of Health Sciences and Technology, Health Ethics and Policy Laboratory, ETH Zürich, Zürich, Switzerland
| | - Effy Vayena
- Department of Health Sciences and Technology, Health Ethics and Policy Laboratory, ETH Zürich, Zürich, Switzerland
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Świątoniowska-Lonc N, Polański J, Mazur G, Jankowska-Polańska B. Impact of Beliefs about Medicines on the Level of Intentional Non-Adherence to the Recommendations of Elderly Patients with Hypertension. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18062825. [PMID: 33802136 PMCID: PMC7998243 DOI: 10.3390/ijerph18062825] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/04/2021] [Accepted: 03/06/2021] [Indexed: 11/24/2022]
Abstract
Background: Non-adherence to pharmaceutical treatment is one of the most common causes of uncontrolled hypertension. Non-adherence may be intentional or unintentional. In the case of intentional non-adherence, it is crucial to understand the reasons behind it. The literature increasingly addresses the issue of beliefs and concerns about medication, but studies on this subject performed in a Polish population of hypertensive patients are still lacking. The aim of the study was to assess the level of intentional non-adherence among patients with hypertension, and to determine the relationship between beliefs about medication and the level of intentional non-adherence to treatment in elderly patients with hypertension. Material and methods: The study included 300 patients (106 of whom were male, mean age (SD) 71.71 (8.12) years) with hypertension, treated at a hypertension clinic. The following instruments were used: the Intentional Non-Adherence Scale (INAS) for evaluating intentional non-adherence, and the Beliefs about Medicines Questionnaire (BMQ) for evaluating patients’ beliefs and opinions regarding medication. Socio-demographic and clinical data were obtained from patients’ medical records. Results: The mean (SD) INAS score in the study was 47.28 (19.12). Patients were most concerned about the harm caused by medication, and least concerned about the necessity to take medication (mean score per item 3.49 vs. 2.14). Correlation analysis demonstrated weak correlations between BMQ and INAS: higher scores for necessity were associated with more intentional non-adherence (r = 0.174, p = 0.003), while higher scores for overuse, harm, and concerns were associated with less intentional non-adherence (respectively: r = −0.253, p < 0.001 vs. r = −0.336, p < 0.001 vs. r = −0.351, p < 0.001). In multiple-factor analysis, factors increasing the level of intentional non-adherence were elderly age (β = −0.352, p = 0.009), multimorbidity (β = −2.374, p = 0.035), and a higher BMQ concerns score (β = −1.376, p < 0.001), while being single was an independent predictor decreasing intentional non-adherence (β = 5.646, p = 0.013). Conclusions: The overall level of intentional non-adherence among patients with hypertension is moderate, but approximately one third of patients with hypertension demonstrate a high level of non-adherence. Independent determinants of intentional non-adherence include concerns, elderly age, multimorbidity, and being single.
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Affiliation(s)
| | - Jacek Polański
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 50-556 Wrocław, Poland; (J.P.); (G.M.)
| | - Grzegorz Mazur
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 50-556 Wrocław, Poland; (J.P.); (G.M.)
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12
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Wong ZS, Siy B, Da Silva Lopes K, Georgiou A. Improving Patients' Medication Adherence and Outcomes in Nonhospital Settings Through eHealth: Systematic Review of Randomized Controlled Trials. J Med Internet Res 2020; 22:e17015. [PMID: 32663145 PMCID: PMC7471892 DOI: 10.2196/17015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 02/24/2020] [Accepted: 04/10/2020] [Indexed: 01/15/2023] Open
Abstract
Background Electronic health (eHealth) refers to the use of information and communication technologies for health. It plays an increasingly important role in patients’ medication management. Objective To assess evidence on (1) whether eHealth for patients’ medication management can improve drug adherence and health outcomes in nonhospital settings and (2) which eHealth functions are commonly used and are effective in improving drug adherence. Methods We searched for randomized controlled trials (RCTs) on PubMed, MEDLINE, CINAHL, EMBASE, EmCare, ProQuest, Scopus, Web of Science, ScienceDirect, and IEEE Xplore, in addition to other published sources between 2000 and 2018. We evaluated the studies against the primary outcome measure of medication adherence and multiple secondary health care outcome measures relating to adverse events, quality of life, patient satisfaction, and health expenditure. The quality of the studies included was assessed using the Cochrane Collaboration’s Risk of Bias (RoB) tool. Results Our initial search yielded 9909 records, and 24 studies met the selection criteria. Of these, 13 indicated improvement in medication adherence at the significance level of P<.1 and 2 indicated an improved quality of life at the significance level of P<.01. The top 3 functions that were employed included mechanisms to communicate with caregivers, monitoring health features, and reminders and alerts. eHealth functions of providing information and education, and dispensing treatment and administration support tended to favor improved medication adherence outcomes (Fisher exact test, P=.02). There were differences in the characteristics of the study population, intervention design, functionality provided, reporting adherence, and outcome measures among the included studies. RoB assessment items, including blinding of outcome assessment and method for allocation concealment, were not explicitly reported in a large number of studies. Conclusions All the studies included were designed for patient home-based care application and provided a mechanism to communicate with caregivers. A targeted study population such as older patients should be considered to maximize the public health impact on the self-management of diseases. Trial Registration International Prospective Register of Systematic Reviews (PROSPERO) CRD42018096627; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=96627
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Affiliation(s)
- Zoie Sy Wong
- Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
| | - Braylien Siy
- Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
| | | | - Andrew Georgiou
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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13
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Abstract
Heart failure management requires intensive care coordination. Guideline-directed medical therapies have been shown to save lives but are practically challenging to implement because of the fragmented care that heart failure patients experience. Electronic health record adoption has transformed the collection and storage of clinical data, but accessing these data often remains prohibitively difficult. Current legislation aims to increase the interoperability of software systems so that providers and patients can easily access the clinical information they desire. Novel heart failure devices and technologies leverage patient-generated data to manage heart failure patients, whereas new data standards make it possible for this information to guide clinical decision-making.
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Affiliation(s)
- Thomas F Byrd
- Department of Medicine (Hospital Medicine), Northwestern University Feinberg School of Medicine, 200 East Ontario Street, Suite 700, Chicago, IL 60611, USA.
| | - Faraz S Ahmad
- Department of Medicine (Cardiology), Center for Health Information Partnerships, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, 676 North Saint Clair, Suite 600, Chicago, IL 60611, USA; Department of Preventive Medicine (Health and Biomedical Informatics), Center for Health Information Partnerships, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, 676 North Saint Clair, Suite 600, Chicago, IL 60611, USA. https://twitter.com/FarazA_MD
| | - David M Liebovitz
- Department of Medicine (General Internal Medicine and Geriatrics), Center for Health Information Partnerships, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, 675 North Street Clair, Suite 18-200, Chicago, IL 60611, USA
| | - Abel N Kho
- Department of Medicine (General Internal Medicine and Geriatrics), Center for Health Information Partnerships, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, 750 North Lake Shore, 10th Floor, Chicago, IL 60611, USA; Department of Preventive Medicine (Health and Biomedical Informatics), Center for Health Information Partnerships, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, 750 North Lake Shore, 10th Floor, Chicago, IL 60611, USA
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14
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Carter G, Chevellereau B, Shahriar H, Sneha S. OpenPharma Blockchain on FHIR: An Interoperable Solution for Read-Only Health Records Exchange through Blockchain and Biometrics. BLOCKCHAIN IN HEALTHCARE TODAY 2020; 3:120. [PMID: 36777058 PMCID: PMC9907413 DOI: 10.30953/bhty.v3.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
The healthcare system in the United States is unique. From payor to provider, patients have the freedom of choice. This creates a complicated and profitable paradigm of care. Legislation defines government expectations of data exchange; however, the methods are left to the discretion of the stakeholders. Today, devices and programs are not built to unified standards, thus they do not share data easily. This communication between software is known as interoperability. We address the health data interoperability by leveraging Fast Health Interoperable Resource (FHIR) standard, a viewer of FHIR called OpenPharma, and Blockchain technology. Our proof of concept, called "OpenPharma Blockchain on FHIR" (OBF), is interoperable by design and grants clinicians access to patient records using a combination of data standards, distributed applications, patient-driven identity management, and the Ethereum blockchain. OBF is a trustless, secure, decentralized, and vendor-independent method for information exchange. It is easy to implement and places the control of records with the patients.
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Affiliation(s)
| | | | | | - Sweta Sneha
- Kennesaw State University, Kennesaw, Georgia
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15
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Olfactory training ball improves adherence and olfactory outcomes in post-infectious olfactory dysfunction. Eur Arch Otorhinolaryngol 2020; 277:2125-2132. [DOI: 10.1007/s00405-020-05939-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 03/20/2020] [Indexed: 01/02/2023]
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16
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Ferreri SP, Hughes TD, Snyder ME. Medication Therapy Management: Current Challenges. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2020; 9:71-81. [PMID: 32309200 PMCID: PMC7136570 DOI: 10.2147/iprp.s179628] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/10/2020] [Indexed: 11/23/2022] Open
Abstract
Medication therapy management (MTM) services have evolved as a means for pharmacists and other providers to assist patients and caregivers in improving therapeutic outcomes and reducing health care expenditures. More than a decade has passed since the Medicare Modernization Act of 2003 provided pharmacists with the opportunity to deliver MTM services to Medicare beneficiaries. MTM continues to offer pharmacists the opportunity to use their knowledge; yet, pharmacists have reported challenges with service delivery. Identifying the challenges that affect MTM services in pharmacy practice is necessary in order to seek improvement to MTM delivery. This narrative review explores the current challenges pharmacists face with MTM delivery, summarizes potential solutions for addressing challenges, and seeks to incite further debate, service reconfiguration, and ultimately service improvement of pharmacist-provided MTM services.
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Affiliation(s)
- Stefanie P Ferreri
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7574, USA
| | - Tamera D Hughes
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7574, USA
| | - Margie E Snyder
- College of Pharmacy, Purdue University, Indianapolis, IN 46202, USA
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17
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Huang Z, Lum E, Jimenez G, Semwal M, Sloot P, Car J. Medication management support in diabetes: a systematic assessment of diabetes self-management apps. BMC Med 2019; 17:127. [PMID: 31311573 PMCID: PMC6636047 DOI: 10.1186/s12916-019-1362-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 06/10/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Smartphone apps are becoming increasingly popular for supporting diabetes self-management. A key aspect of diabetes self-management is appropriate medication-taking. This study aims to systematically assess and characterise the medication management features in diabetes self-management apps and their congruence with best-practice evidence-based criteria. METHODS The Google Play and Apple app stores were searched in June 2018 using diabetes-related terms in the English language. Apps with both medication and blood glucose management features were downloaded and evaluated against assessment criteria derived from international medication management and diabetes guidelines. RESULTS Our search yielded 3369 Android and 1799 iOS potentially relevant apps; of which, 143 apps (81 Android, 62 iOS) met inclusion criteria and were downloaded and assessed. Over half 58.0% (83/143) of the apps had a medication reminder feature; 16.8% (24/143) had a feature to review medication adherence; 39.9% (57/143) allowed entry of medication-taking instructions; 5.6% (8/143) provided information about medication; and 4.2% (6/143) displayed motivational messages to encourage medication-taking. Only two apps prompted users on the use of complementary medicine. Issues such as limited medication logging capacity, faulty reminder features, unclear medication adherence assessment, and visually distracting excessive advertising were observed during app assessments. CONCLUSIONS A large proportion of diabetes self-management apps lacked features for enhancing medication adherence and safety. More emphasis should be given to the design of medication management features in diabetes apps to improve their alignment to evidence-based best practice.
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Affiliation(s)
- Zhilian Huang
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Clinical Sciences Building, Level 18, 11 Mandalay Road, Singapore, 308232, Singapore. .,NTU Institute for Health Technologies (HealthTech NTU), Interdisciplinary Disciplinary School, Nanyang Technological University, Singapore, Singapore.
| | - Elaine Lum
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Clinical Sciences Building, Level 18, 11 Mandalay Road, Singapore, 308232, Singapore.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.,School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Geronimo Jimenez
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Clinical Sciences Building, Level 18, 11 Mandalay Road, Singapore, 308232, Singapore
| | - Monika Semwal
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Clinical Sciences Building, Level 18, 11 Mandalay Road, Singapore, 308232, Singapore
| | - Peter Sloot
- Institute for Advanced Study, University of Amsterdam, Amsterdam, The Netherlands.,ITMO University, Saint Petersburg, Russia.,Complexity Institute, Nanyang Technological University, Singapore, Singapore
| | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Clinical Sciences Building, Level 18, 11 Mandalay Road, Singapore, 308232, Singapore
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18
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Pérez-Jover V, Sala-González M, Guilabert M, Mira JJ. Mobile Apps for Increasing Treatment Adherence: Systematic Review. J Med Internet Res 2019; 21:e12505. [PMID: 31215517 PMCID: PMC6604503 DOI: 10.2196/12505] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 03/28/2019] [Accepted: 05/11/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND It is estimated that 20% to 50% of patients do not take their medication correctly, and this leads to increased morbidity and inefficacy of therapeutic approaches. Fostering treatment adherence is a priority objective for all health systems. The growth of mobile apps to facilitate therapeutic adherence has significantly increased in recent years. However, the effectiveness of the apps for this purpose has not been evaluated. OBJECTIVE This study aimed to analyze whether mobile apps are perceived as useful for managing medication at home and if they actually contribute to increasing treatment adherence in patients. METHODS We carried out a systematic review of research published using Scopus, Cochrane Library, ProQuest, and MEDLINE databases and analyzed the information about their contribution to increasing therapeutic adherence and the perceived usefulness of mobile apps. This review examined studies published between 2000 and 2017. RESULTS Overall, 11 studies fulfilled the inclusion criteria. The sample sizes of these studies varied between 16 and 99 participants. In addition, 7 studies confirmed that the mobile app increased treatment adherence. In 5 of them, the before and after adherence measures suggested significant statistical improvements, when comparing self-reported adherence and missed dose with a percentage increase ranging between 7% and 40%. The users found mobile apps easy to use and useful for managing their medication. The patients were mostly satisfied with their use, with an average score of 8.1 out of 10. CONCLUSIONS The use of mobile apps helps increase treatment adherence, and they are an appropriate method for managing medication at home.
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Affiliation(s)
| | | | - Mercedes Guilabert
- Departamento Psicología de la Salud, Universidad Miguel Hernández, Elche, Spain
| | - José Joaquín Mira
- Departamento Psicología de la Salud, Universidad Miguel Hernández, Elche, Spain
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19
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Doll JA, Hellkamp AS, Thomas L, Fonarow GC, Peterson E, Wang TY. The association of pre- and posthospital medication adherence in myocardial infarction patients. Am Heart J 2019; 208:74-80. [PMID: 30580129 DOI: 10.1016/j.ahj.2018.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 11/07/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nonadherence to optimal medical therapy following myocardial infarction (MI) is associated with adverse clinical outcomes such as stent thrombosis, recurrent cardiovascular events, and death. Whether adherence to medications prior to MI predicts post-MI medication adherence is unknown. METHODS We assessed adherence to P2Y12 inhibitors and statins before and after admission for MI among 8,147 MI patients who had Medicare insurance with Part D prescription coverage. Adherence was defined as a proportion of days covered with medication fills ≥80%. Multivariable logistic regression was used to assess the association between pre- and post-MI P2Y12 inhibitor adherence. As few patients were on P2Y12 inhibitors pre-MI, we also examined the association of pre-MI statin adherence with post-MI P2Y12 inhibitor and statin adherence. RESULTS Pre-MI medication nonadherence was observed in 427 of 2,633 (16%) patients on preadmission P2Y12 inhibitors and 1,233 of 6,934 (18%) patients on preadmission statins. Nonadherent patients were more likely to be of nonwhite race and have multiple prior hospital admissions. Patients who were nonadherent to P2Y12 inhibitors pre-MI were substantially less likely to adhere to P2Y12 inhibitors at 90 days (adjusted odds ratio [OR] 0.33, 95% CI 0.25-0.43) and 1 year post-MI (adjusted OR 0.29, 95% CI 0.21-0.39) compared with patients who were adherent pre-MI. Pre-MI statin nonadherence was also associated with lower post-MI adherence to P2Y12 inhibitors at 90 days (adjusted OR 0.65, 95% CI 0.53-0.79) and 1 year (adjusted OR 0.37, 95% CI 0.29-0.54). CONCLUSIONS Prior medication adherence predicts post-MI adherence to P2Y12 inhibitors. Increasing accessibility of medication adherence data in the medical record may be an important tool to identify patients at higher risk for post-MI medication nonadherence and target efforts to improve adherence.
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20
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Recommendations for the assessment and optimization of adherence to disease-modifying drugs in chronic inflammatory rheumatic diseases: A process based on literature reviews and expert consensus. Joint Bone Spine 2019; 86:13-19. [DOI: 10.1016/j.jbspin.2018.08.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 08/31/2018] [Indexed: 12/21/2022]
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21
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Lavielle M, Puyraimond-Zemmour D, Romand X, Gossec L, Senbel E, Pouplin S, Beauvais C, Gutermann L, Mezieres M, Dougados M, Molto A. Methods to improve medication adherence in patients with chronic inflammatory rheumatic diseases: a systematic literature review. RMD Open 2018; 4:e000684. [PMID: 30116556 PMCID: PMC6088346 DOI: 10.1136/rmdopen-2018-000684] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/14/2018] [Accepted: 05/15/2018] [Indexed: 01/24/2023] Open
Abstract
Objective Lack of adherence to treatment is frequent in chronic inflammatory rheumatic diseases and is associated with poorer outcomes. The objective of this study was to describe and evaluate interventions that have been proposed to enhance medication adherence in these conditions. Methods A systematic literature review was performed in Pubmed, Cochrane, Embase and clinicaltrials.gov databases completed by the rheumatology meeting (ACR, EULAR and SFR) abstracts from last 2 years. All studies in English or French evaluating an intervention to improve medication adherence in chronic inflammatory rheumatic diseases (rheumatoid arthritis (RA), spondyloarthritis (SpA), crystal related diseases, connective tissue diseases, vasculitis and Still's disease) were included. Interventions on adherence were collected and classified in five modalities (educational, behavioural, cognitive behavioural, multicomponent interventions or others). Results 1325 abstracts were identified and 22 studies were finally included (18 studies in RA (72%), 4 studies in systemic lupus erythematosus (16%), 2 studies in SpA (8%) and 1 study in gout (4%)). On 13 randomised controlled trials (RCT) (1535 patients), only 5 were positive (774 patients). Educational interventions were the most represented and had the highest level of evidence: 8/13 RCT (62%, 1017 patients) and 4/8 were positive (50%). In these studies, each patient was individually informed or educated by different actors (physicians, pharmacists, nurses and so on). Supports and contents of these educational interventions were heterogenous. Conclusion Despite the importance of medication adherence in chronic inflammatory rheumatic disorders, evidence on interventions to improve medication adherence is scarce.
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Affiliation(s)
- Matthieu Lavielle
- Rheumatology Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Paris Descartes University, Paris, France
| | | | - Xavier Romand
- Rheumatology Department, Centre Hospitalier Universitaire Grenoble Alpes, Hôpital Sud, Echirolles, France
| | - Laure Gossec
- Sorbonne University, Paris, France.,Rheumatology Department, Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Eric Senbel
- Rheumatology Department, Sainte Marguerite Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Sophie Pouplin
- Rheumatology Department, Hôpitaux de Rouen, Rouen, France
| | - Catherine Beauvais
- Rheumatology Department, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Loriane Gutermann
- Pharmacy Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Maryse Mezieres
- Rheumatology Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Maxime Dougados
- Rheumatology Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Paris Descartes University, Paris, France.,Paris Descartes University, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France
| | - Anna Molto
- Rheumatology Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Paris Descartes University, Paris, France.,Paris Descartes University, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France
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22
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The Digital Drag and Drop Pillbox: Design and Feasibility of a Skill-based Education Model to Improve Medication Management. J Cardiovasc Nurs 2018; 32:E14-E20. [PMID: 28282304 PMCID: PMC5559183 DOI: 10.1097/jcn.0000000000000402] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective: We present the design and feasibility testing for the “Digital Drag and Drop Pillbox” (D-3 Pillbox), a skill-based educational approach that engages patients and providers, measures performance, and generates reports of medication management skills. Methods: A single-cohort convenience sample of patients hospitalized with heart failure was taught pill management skills using a tablet-based D-3 Pillbox. Medication reconciliation was conducted, and aptitude, performance (% completed), accuracy (% correct), and feasibility were measured. Results: The mean age of the sample (n = 25) was 59 (36–89) years, 50% were women, 62% were black, 46% were uninsured, 46% had seventh-grade education or lower, and 31% scored very low for health literacy. However, most reported that the D-3 Pillbox was easy to read (78%), easy to repeat-demonstrate (78%), and comfortable to use (tablet weight) (75%). Accurate medication recognition was achieved by discharge in 98%, but only 25% reported having a “good understanding of my responsibilities.” Conclusions: The D-3 Pillbox is a feasible approach for teaching medication management skills and can be used across clinical settings to reinforce skills and medication list accuracy.
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23
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A population health perspective on a claims and electronic health record-based tool to screen for suboptimal medication adherence. Am Heart J 2018; 197:150-152. [PMID: 29447775 DOI: 10.1016/j.ahj.2017.10.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 10/19/2017] [Indexed: 12/20/2022]
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24
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Elysee G, Herrin J, Horwitz LI. An observational study of the relationship between meaningful use-based electronic health information exchange, interoperability, and medication reconciliation capabilities. Medicine (Baltimore) 2017; 96:e8274. [PMID: 29019898 PMCID: PMC5662321 DOI: 10.1097/md.0000000000008274] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Stagnation in hospitals' adoption of data integration functionalities coupled with reduction in the number of operational health information exchanges could become a significant impediment to hospitals' adoption of 3 critical capabilities: electronic health information exchange, interoperability, and medication reconciliation, in which electronic systems are used to assist with resolving medication discrepancies and improving patient safety. Against this backdrop, we assessed the relationships between the 3 capabilities.We conducted an observational study applying partial least squares-structural equation modeling technique to 27 variables obtained from the 2013 American Hospital Association annual survey Information Technology (IT) supplement, which describes health IT capabilities.We included 1330 hospitals. In confirmatory factor analysis, out of the 27 variables, 15 achieved loading values greater than 0.548 at P < .001, as such were validated as the building blocks of the 3 capabilities. Subsequent path analysis showed a significant, positive, and cyclic relationship between the capabilities, in that decreases in the hospitals' adoption of one would lead to decreases in the adoption of the others.These results show that capability for high quality medication reconciliation may be impeded by lagging adoption of interoperability and health information exchange capabilities. Policies focused on improving one or more of these capabilities may have ancillary benefits.
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Affiliation(s)
- Gerald Elysee
- Health Information Technology Programs, Department of Computer Technology, Benjamin Franklin Institute of Technology, Boston, MA
| | - Jeph Herrin
- Section of Cardiology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Leora I. Horwitz
- Division of Healthcare Delivery Science, Department of Population Health, NYU School of Medicine, Center for Healthcare Innovation and Delivery Science, NYU Langone Health, New York, NY, USA
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25
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Whalley Buono E, Vrijens B, Bosworth HB, Liu LZ, Zullig LL, Granger BB. Coming full circle in the measurement of medication adherence: opportunities and implications for health care. Patient Prefer Adherence 2017; 11:1009-1017. [PMID: 28652710 PMCID: PMC5472434 DOI: 10.2147/ppa.s127131] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
There is little debate that medication nonadherence is a major public health issue and that measuring nonadherence is a crucial step toward improving it. Moreover, while measuring adherence is becoming both more feasible and more common in the era of electronic information, the reliability and usefulness of various measurements of adherence have not been well established. This paper outlines the most commonly used measures of adherence and discusses the advantages and disadvantages of each that depend on the purpose for which the measure will be used. International consensus statements on definitions and guidelines for selection and use of medication adherence measures were reviewed. The quality of recommended measures was evaluated in selected publications from 2009 to 2014. The most robust medication adherence measures are often ill suited for large-scale use. Less robust measures were found to be commonly misapplied and subsequently misinterpreted in population-level analyses. Adherence assessment and measurement were rarely integrated into standard patient care practice patterns. Successful scalable and impactful strategies to improve medication adherence will depend on understanding how to efficiently and effectively measure adherence.
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Affiliation(s)
| | | | - Hayden B Bosworth
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Larry Z Liu
- Center for Observational and Real World Evidence, Merck, Rahway, NJ and Weill Medical College of Cornell University, New York, NY
| | - Leah L Zullig
- Division of General Internal Medicine, Duke University School of Medicine
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System
| | - Bradi B Granger
- Duke University School of Nursing
- Heart Center Nursing Research Program, Duke University Health System, Durham, NC, USA
- Correspondence: Bradi B Granger, Heart Center Nursing Research Program, Duke University Health System, 307 Trent Drive, DUMC 3322 Durham, NC 27710, USA, Tel +1 919 684 1622, Email
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26
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Meguerditchian A, Tamblyn R, Meterissian S, Law S, Prchal J, Winslade N, Stern D. Adjuvant Endocrine Therapy in Breast Cancer: A Novel e-Health Approach in Optimizing Treatment for Seniors (OPTIMUM): A Two-Group Controlled Comparison Pilot Study. JMIR Res Protoc 2016; 5:e199. [PMID: 27821385 PMCID: PMC5118585 DOI: 10.2196/resprot.6519] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 09/20/2016] [Accepted: 09/20/2016] [Indexed: 12/13/2022] Open
Abstract
Background In women with hormone receptor positive breast cancer, adjuvant endocrine therapy (AET) is associated with a significant survival advantage. Nonadherence is a particular challenge in older women, even though they stand to benefit the most from AET. Therefore, a novel eHealth tool (OPTIMUM) that integrates real-time analysis of health administrative claims data was developed to provide point-of-care decision support for clinicians. Objectives The objectives of the study are to determine the effectiveness of a patient-specific, real-time eHealth alert delivered at point-of-care in reducing rates of AET discontinuation and to understand patient-level factors related to AET discontinuation as well as to assess integration of eHealth alerts regarding deviations from best practices in administration of AET by cancer care teams. Methods A prospective, 2-group controlled comparison pilot study will be conducted at 2 urban, McGill University–affiliated hospitals, the Royal Victoria Hospital and St. Mary’s Hospital. A minimum of 43 patients per study arm will be enrolled through site-level allocation. Follow-up is 1.5 years. Health care professionals at the intervention site will have access to the eHealth tool, which will report to them in real-time medical events with known associations to AET discontinuation, an AET adherence monitor, and a discontinuation alert. Cox proportional hazard ratios with 95% confidence intervals will estimate risks of AET discontinuation. Tests for significance will be 2-sided with a significance level of P<.05. Results This protocol has been approved and funded by the Canadian Institutes of Health Research. The study will evaluate site-level differences between AET discontinuation and AET adherence and assess care team actions at the intervention site. Participant enrollment into this project is expected to start September 2016 with primary data ready to present by June 2018. Conclusion This study will offer an opportunity to verify the feasibility of integrating an eHealth tool that aims to improve the long-term management of breast cancer in a high-risk population by allowing more timely intervention to prevent or rapidly address AET discontinuation.
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Affiliation(s)
- Ari Meguerditchian
- Clinical and Health Informatics Research Group, McGill University, Montreal, QC, Canada.,Department of Surgery, McGill University, Montreal, QC, Canada.,Department of Oncology, McGill University, Montreal, QC, Canada.,Breast Clinic, McGill University Health Centre, Montreal, QC, Canada
| | - Robyn Tamblyn
- Clinical and Health Informatics Research Group, McGill University, Montreal, QC, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.,Department of Medicine, McGill University, Montreal, QC, Canada
| | - Sarkis Meterissian
- Department of Surgery, McGill University, Montreal, QC, Canada.,Department of Oncology, McGill University, Montreal, QC, Canada.,Breast Clinic, McGill University Health Centre, Montreal, QC, Canada
| | - Susan Law
- Department of Family Medicine, McGill University, Montreal, QC, Canada.,Research Centre, St. Mary's Hospital, Montreal, QC, Canada
| | - Jaroslav Prchal
- Department of Oncology, McGill University, Montreal, QC, Canada.,Department of Oncology, St. Mary's Hospital Center, Montreal, QC, Canada
| | - Nancy Winslade
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Donna Stern
- Department of Oncology, St. Mary's Hospital Center, Montreal, QC, Canada
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