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Lammila-Escalera E, Greenfield G, Pan Z, Nicholls D, Majeed A, Hayhoe B. Interventions to improve medication adherence in adults with mental-physical multimorbidity in primary care: a systematic review. Br J Gen Pract 2024; 74:e442-e448. [PMID: 38429109 PMCID: PMC11181560 DOI: 10.3399/bjgp.2023.0406] [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] [Received: 08/15/2023] [Accepted: 02/26/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Medication non-adherence is a notable contributor to healthcare inefficiency, resulting in poor medication management, impaired patient outcomes, and ineffective symptom control. AIM To summarise interventions targeting medication adherence for adults with mental-physical multimorbidity in primary healthcare settings. DESIGN AND SETTING A systematic review of the literature - published in any language and with any country of origin - was conducted. METHOD MEDLINE, EMBASE, PsycInfo, Web of Science, Cochrane Library, and the Cumulated Index to Nursing and Allied Health Literature - more commonly known as CINAHL - were searched for relevant studies. Data were extracted and synthesised using narrative synthesis. The Effective Practice and Organisation of Care (EPOC) taxonomy was used to classify intervention types. Risk of bias was assessed using the National Heart, Lung, and Blood Institute's quality assessment tool for controlled intervention studies. RESULTS Eleven studies, representing 2279 patients, were included. All interventions examined were classified into one EPOC domain, namely 'delivery arrangements'. All included studies examined patients who had a physical condition and depression. Seven studies examining interventions focused on coordination of care and management of care processes reported statistically significant improvements in medication adherence that were attributed to the intervention. Four studies considering the use of information and communication technology observed no changes in medication adherence. CONCLUSION Interventions that coordinate and manage healthcare processes may help improve patients' adherence to medication regimes in those with mental-physical multimorbidity. However, it is still necessary to better understand how digital health technology can support patients in following their medication regimes. As the growing challenges of treating multimorbidity are faced, everyone involved in health services - from providers to policymakers - must be receptive to a more integrated approach to healthcare delivery.
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Affiliation(s)
| | | | - Ziyang Pan
- Department of Primary Care and Public Health
| | | | | | - Benedict Hayhoe
- Department of Primary Care and Public Health, Imperial College London, London
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Vilasi A, Panuccio VA, Morante S, Villa A, Versace MC, Mezzatesta S, Mercuri S, Inguanta R, Aiello G, Cutrupi D, Puglisi R, Capria S, Li Vigni M, Tripepi G, Torino C. Monitoring Risk Factors and Improving Adherence to Therapy in Patients With Chronic Kidney Disease (Smit-CKD Project): Pilot Observational Study. JMIR BIOINFORMATICS AND BIOTECHNOLOGY 2022; 3:e36766. [PMID: 38935948 PMCID: PMC11135230 DOI: 10.2196/36766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/26/2022] [Accepted: 11/05/2022] [Indexed: 06/29/2024]
Abstract
BACKGROUND Chronic kidney disease is a major public health issue, with about 13% of the general adult population and 30% of the elderly affected. Patients in the last stage of this disease have an almost uniquely high risk of death and cardiovascular events, with reduced adherence to therapy representing an additional risk factor for cardiovascular morbidity and mortality. Considering the increased penetration of mobile phones, a mobile app could educate patients to autonomously monitor cardiorenal risk factors. OBJECTIVE With this background in mind, we developed an integrated system of a server and app with the aim of improving self-monitoring of cardiovascular and renal risk factors and adherence to therapy. METHODS The software infrastructure for both the Smit-CKD server and Smit-CKD app was developed using standard web-oriented development methodologies preferring open source tools when available. To make the Smit-CKD app suitable for Android and iOS, platforms that allow the development of a multiplatform app starting from a single source code were used. The integrated system was field tested with the help of 22 participants. User satisfaction and adherence to therapy were measured by questionnaires specifically designed for this study; regular use of the app was measured using the daily reports available on the platform. RESULTS The Smit-CKD app allows the monitoring of cardiorenal risk factors, such as blood pressure, weight, and blood glucose. Collected data are transmitted in real time to the referring general practitioner. In addition, special reminders improve adherence to the medication regimen. Via the Smit-CKD server, general practitioners can monitor the clinical status of their patients and their adherence to therapy. During the test phase, 73% (16/22) of subjects entered all the required data regularly and sent feedback on drug intake. After 6 months of use, the percentage of regular intake of medications rose from 64% (14/22) to 82% (18/22). Analysis of the evaluation questionnaires showed that both the app and server components were well accepted by the users. CONCLUSIONS Our study demonstrated that a simple mobile app, created to self-monitor modifiable cardiorenal risk factors and adherence to therapy, is well tolerated by patients affected by chronic kidney disease. Further studies are required to clarify if the use of this integrated system will have long-term effects on therapy adherence and if self-monitoring of risk factors will improve clinical outcomes in this population.
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Affiliation(s)
- Antonio Vilasi
- Institute of Clinical Physiology, National Research Council, Reggio Calabria, Italy
| | | | | | | | | | - Sabrina Mezzatesta
- Institute of Clinical Physiology, National Research Council, Reggio Calabria, Italy
| | | | | | - Giuseppe Aiello
- Department of Engineering, University of Palermo, Palermo, Italy
| | - Demetrio Cutrupi
- Institute of Clinical Physiology, National Research Council, Reggio Calabria, Italy
| | | | - Salvatore Capria
- Institute of Clinical Physiology, National Research Council, Reggio Calabria, Italy
| | | | - Giovanni Tripepi
- Institute of Clinical Physiology, National Research Council, Reggio Calabria, Italy
| | - Claudia Torino
- Institute of Clinical Physiology, National Research Council, Reggio Calabria, Italy
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Dinari F, Bahaadinbeigy K, Moulaei K. Analysis of requirements for developing a mobile device‐based medicines management application for people who are blind and visually impaired. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2022. [DOI: 10.1002/jppr.1775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Fatemeh Dinari
- Medical Informatics Research Centre Institute for Futures Studies in Health Kerman University of Medical Sciences Kerman Iran
| | - Kambiz Bahaadinbeigy
- Medical Informatics Research Centre Institute for Futures Studies in Health Kerman University of Medical Sciences Kerman Iran
| | - Khadijeh Moulaei
- Medical Informatics Research Centre Institute for Futures Studies in Health Kerman University of Medical Sciences Kerman Iran
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Use of Non-Cancer Medications in New Zealand Women at the Diagnosis of Primary Invasive Breast Cancer: Prevalence, Associated Factors and Effects on Survival. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217962. [PMID: 33138255 PMCID: PMC7663632 DOI: 10.3390/ijerph17217962] [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] [Received: 08/28/2020] [Revised: 10/20/2020] [Accepted: 10/26/2020] [Indexed: 11/17/2022]
Abstract
Background: Assessing the use of multiple medications in cancer patients is crucial as such use may affect cancer outcomes. This study reports the prevalence of non-cancer medication use at breast cancer diagnosis, its associated factors, and its effect on survival. Methods: We identified all women diagnosed with primary invasive breast cancer between 1 January 2007 and 31 December 2016, from four population-based breast cancer registries, in Auckland, Waikato, Wellington, and Christchurch, New Zealand. Through linkage to the pharmaceutical records, we obtained information on non-cancer medications that were dispensed for a minimum of 90 days’ supply between one year before cancer diagnosis and first cancer treatment. We performed ordered logistic regressions to identify associated factors and Cox regressions to investigate its effect on patient survival. Results: Of 14,485 patients, 52% were dispensed at least one drug (mean—1.3 drugs; maximum—13 drugs), with a higher prevalence observed in patients who were older, treated at a public facility, more economically deprived, and screen-detected. The use of 2–3 drugs showed a reduced non-breast cancer mortality (HR = 0.75, 95%CI = 0.60–0.92) in previously hospitalised patients, with other groups showing non-significant associations when adjusted for confounding factors. Drug use was not associated with changes in breast cancer-specific mortality. Conclusions: Non-cancer medication use at breast cancer diagnosis was common in New Zealand, more prevalent in older and disadvantaged women, and showed no effect on breast cancer-specific mortality, but a reduction in other cause mortality with the use of 2–3 drugs.
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Tabi K, Randhawa AS, Choi F, Mithani Z, Albers F, Schnieder M, Nikoo M, Vigo D, Jang K, Demlova R, Krausz M. Mobile Apps for Medication Management: Review and Analysis. JMIR Mhealth Uhealth 2019; 7:e13608. [PMID: 31512580 PMCID: PMC6786858 DOI: 10.2196/13608] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 05/31/2019] [Accepted: 06/22/2019] [Indexed: 12/31/2022] Open
Abstract
Background Pharmacotherapy remains one of the major interventional strategies in medicine. However, patients from all age groups and conditions face challenges when taking medications, such as integrating them into the daily routine, understanding their effects and side effects, and monitoring outcomes. In this context, a reliable medication management tool adaptable to the patient’s needs becomes critical. As most people have a mobile phone, mobile apps offer a platform for such a personalized support tool available on the go. Objective This study aimed to provide an overview of available mobile apps, focusing on those that help patients understand and take their medications. We reviewed the existing apps and provided suggestions for future development based on the concept understand and manage, instead of the conventional adhere to medication. This concept aims to engage and empower patients to be in charge of their health, as well as see medication as part of a broader clinical approach, working simultaneously with other types of interventions or lifestyle changes, to achieve optimal outcomes. Methods We performed a Web search in the iOS Apple App Store and Android Google Play Store, using 4 search terms: medication management, pill reminder, medication health monitor, and medication helper. We extracted information from the app store descriptions for each eligible app and categorized into the following characteristics: features, author affiliation, specialty, user interface, cost, and user rating. In addition, we conducted Google searches to obtain more information about the author affiliation. Results A total of 328 apps (175 Android and 153 iOS) were categorized. The majority of the apps were developed by the software industry (73%, 11/15), a minority of them were codeveloped by health care professionals (15%, 3/20) or academia (2.1%; 7/328). The most prevalent specialty was diabetes (23 apps). Only 7 apps focused on mental health, but their content was highly comprehensive in terms of features and had the highest prevalence of the education component. The most prevalent features were reminder, symptom tracker, and ability to share data with a family member or doctor. In addition, we highlighted the features considered innovative and listed practical suggestions for future development and innovations. Conclusions We identified detailed characteristics of the existing apps, with the aim of informing future app development. Ultimately, the goal was to provide users with effective mobile health solutions, which can be expected to improve their engagement in the treatment process and long-term well-being. This study also highlighted the need for improved standards for reporting on app stores. Furthermore, it underlined the need for a platform to offer health app users an ongoing evaluation of apps by health professionals in addition to other users and to provide them with tools to easily select an appropriate and trustworthy app.
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Affiliation(s)
- Katarina Tabi
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,Department of Pharmacology, Masaryk University, Brno, Czech Republic
| | | | - Fiona Choi
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC, Canada
| | - Zamina Mithani
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Friederike Albers
- Center of Human Movement Sciences, University of Groningen, Groningen, Netherlands
| | - Maren Schnieder
- Wolfson School of Mechanical, Electrical and Manufacturing Engineering, Loughborough University, Loughborough, United Kingdom
| | - Mohammadali Nikoo
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Daniel Vigo
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
| | - Kerry Jang
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Regina Demlova
- Department of Pharmacology, Masaryk University, Brno, Czech Republic
| | - Michael Krausz
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC, Canada
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