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Ali A, Clarke DF. Digital measures in epilepsy in low-resourced environments. Expert Rev Pharmacoecon Outcomes Res 2024; 24:705-712. [PMID: 37818647 DOI: 10.1080/14737167.2023.2270163] [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: 07/14/2023] [Accepted: 10/09/2023] [Indexed: 10/12/2023]
Abstract
INTRODUCTION Digital measures and digital health-care delivery have been rarely implemented in lower-and-middle-income countries (LMICs), contributing to worsening global disparities and inequities. Sustainable ways to implement and use digital approaches will help to improve time to access, management, and quality of life in persons with epilepsy, goals that remain unreachable in under-resourced communities. As under-resourced environments differ in human and economic resources, no one approach will be appropriate to all LMICs. AREAS COVERED Digital health and tools to monitor and measure digital endpoints and metrics of quality of life will need to be developed or adapted to the specific needs of under-resourced areas. Portable technologies may partially address the urban-rural divide. Careful delineation of stakeholders and their engagement and alignment in all efforts is critically important if these initiatives are to be successfully sustained. Privacy issues, neglected in many regions globally, must be purposefully addressed. EXPERT OPINION Epilepsy care in under-resourced environments has been limited by the lack of relevant technologies for diagnosis and treatment. Digital biomarkers, and investigative technological advances, may finally make it feasible to sustainably improve care delivery and ultimately quality of life including personalized epilepsy care.
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Affiliation(s)
- Amza Ali
- Department of Medicine, Faculty of Medical Sciences, Mona, Kingston, Jamaica
| | - Dave F Clarke
- Dell Medical School, University of Texas at Austin, Austin, TX, USA
- Department of Pediatric Epilepsy, Dell Children's Medical Center of Central Texas, Austin, TX, USA
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Kangwal C, Thato R, Ua-Kit N, Visudtibhan A. Interventions to promote medication adherence among children with epilepsy: An integrative review. J Pediatr Nurs 2024:S0882-5963(24)00243-4. [PMID: 38944619 DOI: 10.1016/j.pedn.2024.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 06/13/2024] [Accepted: 06/13/2024] [Indexed: 07/01/2024]
Abstract
PROBLEM Many children with epilepsy face challenges in adhering to their medication, leading to inadequate seizure control. However, the most effective intervention is still unclear. This integrative review's main goal was to examine and synthesize the existing literature on interventions for promoting medication adherence in children with epilepsy. ELIGIBILITY CRITERIA This integrative review followed Whittemore and Knafl's five-stage framework. Four electronic databases (PubMed, ScienceDirect, Scopus, and CINAHL Complete) were systematically searched from 2013 until 2024 to identify eligible studies published in the English language. The key search terms included "Children with epilepsy" AND "medication adherence" AND "intervention." Studies reporting on the implementation and evaluation of medication adherence interventions in children with epilepsy were eligible. Quality assessment and narrative synthesis were subsequently undertaken. SAMPLE A total of 17 studies were included in the review. RESULTS Five interventions were found, including educational, behavioral, and mixed intervention types, using technology and family involvement. Promoting medication adherence is crucial, but tailored interventions for different age groups and sustained support are needed. CONCLUSIONS Promoting medication adherence is of utmost importance to enhance the knowledge of children who have epilepsy and their families, and to increase medication adherence. However, there is still a need to develop interventions that are appropriate for children of different ages and their families, which should be suitable and sustainable during treatment. IMPLICATIONS Pediatric nurses should consider socioeconomic factors, ethnicity, family functioning, and parental distress. Strategies include monitoring adherence, continuous communication, and technology support for children with epilepsy during treatment.
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Affiliation(s)
- Chutimaporn Kangwal
- Research Unit for Enhancing Well-being in Vulnerable and Chronic Illness Populations, Faculty of Nursing Chulalongkorn University, Thailand.
| | - Ratsiri Thato
- Research Unit for Enhancing Well-being in Vulnerable and Chronic Illness Populations, Faculty of Nursing Chulalongkorn University, Thailand.
| | - Noraluk Ua-Kit
- Research Unit for Enhancing Well-being in Vulnerable and Chronic Illness Populations, Faculty of Nursing Chulalongkorn University, Thailand
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Bandiera C, Pasquier J, Locatelli I, Schneider MP. Using a Semiautomated Procedure (CleanADHdata.R Script) to Clean Electronic Adherence Monitoring Data: Tutorial. JMIR Form Res 2024; 8:e51013. [PMID: 38776539 PMCID: PMC11153970 DOI: 10.2196/51013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 01/15/2024] [Accepted: 02/05/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Patient adherence to medications can be assessed using interactive digital health technologies such as electronic monitors (EMs). Changes in treatment regimens and deviations from EM use over time must be characterized to establish the actual level of medication adherence. OBJECTIVE We developed the computer script CleanADHdata.R to clean raw EM adherence data, and this tutorial is a guide for users. METHODS In addition to raw EM data, we collected adherence start and stop monitoring dates and identified the prescribed regimens, the expected number of EM openings per day based on the prescribed regimen, EM use deviations, and patients' demographic data. The script formats the data longitudinally and calculates each day's medication implementation. RESULTS We provided a simulated data set for 10 patients, for which 15 EMs were used over a median period of 187 (IQR 135-342) days. The median patient implementation before and after EM raw data cleaning was 83.3% (IQR 71.5%-93.9%) and 97.3% (IQR 95.8%-97.6%), respectively (Δ+14%). This difference is substantial enough to consider EM data cleaning to be capable of avoiding data misinterpretation and providing a cleaned data set for the adherence analysis in terms of implementation and persistence. CONCLUSIONS The CleanADHdata.R script is a semiautomated procedure that increases standardization and reproducibility. This script has broader applicability within the realm of digital health, as it can be used to clean adherence data collected with diverse digital technologies.
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Affiliation(s)
- Carole Bandiera
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
| | - Jérôme Pasquier
- Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Isabella Locatelli
- Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Marie P Schneider
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
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Serina PT, Bounds M, Dandapani H, Carnes TC, Linnebur SA, Gomez Picazo J, Keene SE, Goldberg EM. Could digital pills improve medication adherence in persons living with dementia? A qualitative study. J Am Geriatr Soc 2024. [PMID: 38651668 DOI: 10.1111/jgs.18932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/15/2024] [Accepted: 03/25/2024] [Indexed: 04/25/2024]
Affiliation(s)
- Peter T Serina
- Department of Emergency Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Brown University, Center for Gerontology and Healthcare Research Providence, Rhode Island, USA
| | - Megan Bounds
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Hari Dandapani
- Department of Emergency Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | | | - Sunny A Linnebur
- Skaggs School of Pharmacy & Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jonathan Gomez Picazo
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Sarah E Keene
- Department of Emergency Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Elizabeth M Goldberg
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
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Lee-Riddle GS, Schmidt HJ, Reese PP, Nelson MN, Neergaard R, Barg FK, Serper M. Transplant recipient, care partner, and clinician perceptions of medication adherence monitoring technology: A mixed methods study. Am J Transplant 2024; 24:669-680. [PMID: 37923085 DOI: 10.1016/j.ajt.2023.10.030] [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: 08/28/2023] [Revised: 10/28/2023] [Accepted: 10/30/2023] [Indexed: 11/07/2023]
Abstract
Medication nonadherence is a leading cause of graft loss. Adherence monitoring technologies-reminder texts, smart bottles, video-observed ingestion, and digestion-activated signaling pills-may support adherence. However, patient, care partner, and clinician perceptions of these tools are not well studied. We conducted qualitative individual semistructured interviews and focus groups among 97 participants at a single center: kidney and liver transplant recipients 2 weeks to 18 months posttransplant, their care partners, and transplant clinicians. We assessed adherence practices, reactions to monitoring technologies, and opportunities for care integration. One-size-fits-all approaches were deemed infeasible. Interviewees considered text messages the most acceptable approach; live video checks were the least acceptable and raised the most concerns for inconvenience and invasiveness. Digestion-activated signaling technology produced both excitement and apprehension. Patients and care partners generally aligned in perceptions of adherence monitoring integration into clinical care. Key themes were importance of routine, ease of use, leveraging technology for actionable medication changes, and aversion to surveillance. Transplant clinicians similarly considered text messages most acceptable and video checks least acceptable. Clinicians reported that early posttransplant use and real-time adherence tracking with patient feedback may facilitate successful implementation. The study provides initial insights that may inform future adherence technology implementation.
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Affiliation(s)
- Grace S Lee-Riddle
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Harald J Schmidt
- Department of Medical Ethics & Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Peter P Reese
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maria N Nelson
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rebecca Neergaard
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Frances K Barg
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Marina Serper
- Division of Gastroenterology and Hepatology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Kim B, Hu J. The Effectiveness of Cognitive-Focused Interventions for Adults With Diabetes: A Systematic Review. West J Nurs Res 2024; 46:236-247. [PMID: 38205721 DOI: 10.1177/01939459231221939] [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: 01/12/2024]
Abstract
BACKGROUND Adults with diabetes and impaired memory and executive functions are more likely to experience difficulties in diabetes self-management and achieving glycemic targets. The purpose of this systematic review was to evaluate the evidence of the effects of cognitive-focused interventions on cognitive ability, diabetes self-management, and management of glycemic levels for middle-aged adults and older adults with diabetes. METHODS A systematic review of randomized controlled/clinical trials published in English between 2012 and 2022 was conducted. A search was performed using 5 databases (PubMed, CINAHL, Embase, Web of Science, and Scopus) in addition to hand-searching. The search terms included diabetes, adults, cognitive-focused intervention, cognition, self-management, and hemoglobin A1C (HbA1C). RESULTS Eleven studies met the inclusion criteria. Cognitive ability and diabetes self-management were assessed using different measurements, and glycemic levels were measured with HbA1C. Nine studies applied cognitive training, one provided working memory training, and one used occupational therapy. Eight studies combined cognitive training with a co-intervention, including self-efficacy, lifestyle management, physical training, chronic disease self-management program, square-stepping exercise, psychoeducational intervention, and empowerment. Eight studies showed statistically significant improvements in at least one cognitive domain. CONCLUSIONS Cognitive-focused interventions have a positive effect on improving memory and executive function. However, the evidence of cognitive-focused interventions on diabetes self-management and glycemic levels has not been established. Future studies to improve cognition using effective strategies to improve cognitive function enhancing diabetes self-management behaviors and managing glycemic levels are warranted.
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Affiliation(s)
- Bohyun Kim
- The Ohio State University, College of Nursing, Columbus, OH, USA
| | - Jie Hu
- The Ohio State University, College of Nursing, Columbus, OH, USA
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Moreo K, Sapir T. Growth of Remote Therapeutic Monitoring Lands New Opportunities for Case Management. Prof Case Manag 2024; 29:63-69. [PMID: 38015812 DOI: 10.1097/ncm.0000000000000688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
PURPOSE/OBJECTIVES An increase in the use of remote therapeutic monitoring (RTM) has been spurred by nationwide factors including the COVID-19 pandemic, authorized reimbursement of RTM by the Centers for Medicare & Medicaid Services, and more frequent use of big data analytics in health care delivery. This article discusses the use of RTM by care teams at the point of care and explores the role of the case manager in RTM to address patients' unmet needs. PRIMARY PRACTICE SETTINGS Although RTM may be utilized across inpatient and outpatient levels of care, this article focuses on outpatient care such as community clinics, provider groups, and home health care. FINDINGS/CONCLUSIONS When implemented along with care management interventions, RTM applications have the potential to improve patient adherence, enhance communication between patients and their providers, streamline resource allocation, and address social determinants of health impacting patient care and outcomes. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE RTM reimbursement models are rapidly evolving, utilizing real-world and patient-reported data to identify and initiate timely, individualized solutions that meet the holistic needs of each patient. Use of an RTM system allows the case manager to build rapport with the patient while quickly identifying care gaps and delivering appropriate interventions that can maximize patient outcomes. RTM can drive savings and bring revenue to the system or practice while providing salient documentation of social determinants of health that can be addressed with validation of proven care coordination interventions.
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Affiliation(s)
- Kathleen Moreo
- Kathleen Moreo, BSN, BHSA, RN, CCM, CMGT-BC, CDMS, FCM, was recently inducted into the Class of 2023 Fellows of Case Management by the Case Management Society of America (CMSA) and is a past recipient of the CMSA Case Manager of the Year Award, as well as a CMSA Past President. A researcher and educator, Moreo has published extensively in peer-reviewed medical journals and has authored two books on nursing case management for the American Nurses Association. She currently serves in advisory capacities and volunteers in both health care and environmental causes
- Tamar Sapir, PhD, is the CEO and Founder of Synchronyx, a health tech company addressing gaps in medication adherence and care connectivity. She holds an MSc and a PhD degree from Bar-Ilan University and postdoctoral and business degrees from the University of Miami, FL. She is the author of more than 80 peer-reviewed publications, of which many focus on quality improvement, patient-provider connected tools, and health inequities
| | - Tamar Sapir
- Kathleen Moreo, BSN, BHSA, RN, CCM, CMGT-BC, CDMS, FCM, was recently inducted into the Class of 2023 Fellows of Case Management by the Case Management Society of America (CMSA) and is a past recipient of the CMSA Case Manager of the Year Award, as well as a CMSA Past President. A researcher and educator, Moreo has published extensively in peer-reviewed medical journals and has authored two books on nursing case management for the American Nurses Association. She currently serves in advisory capacities and volunteers in both health care and environmental causes
- Tamar Sapir, PhD, is the CEO and Founder of Synchronyx, a health tech company addressing gaps in medication adherence and care connectivity. She holds an MSc and a PhD degree from Bar-Ilan University and postdoctoral and business degrees from the University of Miami, FL. She is the author of more than 80 peer-reviewed publications, of which many focus on quality improvement, patient-provider connected tools, and health inequities
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8
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Al Meslamani AZ. Policy solutions for medication non-adherence: what can governments do? Expert Rev Pharmacoecon Outcomes Res 2024:1-5. [PMID: 38366855 DOI: 10.1080/14737167.2024.2321242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 02/16/2024] [Indexed: 02/18/2024]
Affiliation(s)
- Ahmad Z Al Meslamani
- College of Pharmacy, Al Ain University, Abu Dhabi, United Arab Emirates
- AAU Health and Biomedical Research quality of care Center, Al Ain University, Abu Dhabi, United Arab Emirates
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Kalichman SC, Banas E, Shkembi B, Kalichman M, Mathews C. The three-item patient-reported instrument for retrospective adherence in resource constrained settings: reliability, validity and potential utility. J Behav Med 2024; 47:135-143. [PMID: 37524887 DOI: 10.1007/s10865-023-00438-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/17/2023] [Indexed: 08/02/2023]
Abstract
INTRODUCTION Patient-report instruments remain the most feasible and sustainable approaches for monitoring medication adherence in clinical settings. However, questions of their reliability and validity persist. Studies suggest that the 3-item instrument for retrospective adherence (IRA) developed by Wilson et al. offers a viable option for clinically monitoring medication adherence. Here we report the reliability and validity of the IRA among patients recruited from community-based HIV clinics and antiretroviral therapy (ART) dispensaries in a resource constrained township in Cape Town, South Africa. METHODS Women (n = 794) and men (n = 228) receiving ART completed the IRA at three time points: (a) in a face-to-face administration at enrollment (b) in1-week phone interview and (c) 1-month phone interview. Participants also provided contemporaneous blood samples for HIV viral load testing as a clinical outcome and unannounced phone-based pill counts as an objective assessment of ART adherence. RESULTS The IRA was internally consistent and showed evidence of time stability. The IRA also demonstrated validity with respect to pill count adherence, correlates of adherence, and HIV viral load. Response operating curve analysis yielded an area under the curve of 0.646, using 75% adherence as the cut-off, with 0.637 sensitivity and 0.567 specificity. CONCLUSIONS The IRA demonstrated reliability, construct validity and criterion validity in a resource constrained setting, supporting use of the IRA in research and clinical care.
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Affiliation(s)
- Seth C Kalichman
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA.
| | - Ellen Banas
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Bruno Shkembi
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA
| | - Moira Kalichman
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA
| | - Catherine Mathews
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
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Rane K, Kukreja G, Deshmukh S, Kakad U, Jadhav P, Patole V. Robotic Pills as Innovative Personalized Medicine Tools: A Mini Review. RECENT ADVANCES IN DRUG DELIVERY AND FORMULATION 2024; 18:2-11. [PMID: 38841731 DOI: 10.2174/0126673878265457231205114925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/13/2023] [Accepted: 11/17/2023] [Indexed: 06/07/2024]
Abstract
The most common route for drug administration is the oral route due to the various advantages offered by this route, such as ease of administration, controlled and sustained drug delivery, convenience, and non-invasiveness. In spite of this, oral drug absorption faces challenges due to various issues related to its stability, permeability and solubility in the GI tract. Biologic drugs generally face problems when administered by oral route as they are readily degradable and thus required to be injected. To overcome these issues in oral absorption, different approaches like novel drug delivery systems and newer pharmaceutical technologies have been adopted. With a combined knowledge of drug delivery and pharmaceutical technology, robotic pills can be designed and used successfully to enhance the adhesion and permeation of drugs through the mucus membrane of the GI tract to achieve drug delivery at the target site. The potential application of robotic pills in diagnosis and drug dispensing is also discussed. The review highlights recent developments in robotic pill drug-device technology and discusses its potential applications to solve the problems and challenges in oral drug delivery.
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Affiliation(s)
- Komal Rane
- Department of Pharmacy Practice, Dr. D.Y. Patil Institute of Pharmaceutical Sciences and Research, Pimpri, Pune - 411018, Maharashtra, India
| | - Garima Kukreja
- Department of Pharmacy Practice, Dr. D.Y. Patil Institute of Pharmaceutical Sciences and Research, Pimpri, Pune - 411018, Maharashtra, India
| | - Siddhi Deshmukh
- Department of Pharmacy Practice, Dr. D.Y. Patil Institute of Pharmaceutical Sciences and Research, Pimpri, Pune - 411018, Maharashtra, India
| | - Urmisha Kakad
- Department of Pharmacy Practice, Dr. D.Y. Patil Institute of Pharmaceutical Sciences and Research, Pimpri, Pune - 411018, Maharashtra, India
| | - Pranali Jadhav
- Department of Pharmaceutical Chemistry, Dr. D.Y. Patil Institute of Pharmaceutical Sciences and Research, Pimpri, Pune - 411018, Maharashtra, India
| | - Vinita Patole
- Department of Pharmaceutics, Dr. D.Y. Patil Institute of Pharmaceutical Sciences and Research, Pimpri, Pune - 411018, Maharashtra, India
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Elkefi S, Blecker S, Bitan Y. Health Information Technology Supporting Adherence Memory Disorder Patients: A Systematic Literature Review. Appl Clin Inform 2024; 15:85-100. [PMID: 38295858 PMCID: PMC10830240 DOI: 10.1055/s-0043-1776792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 10/09/2023] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND People with memory disorders have difficulty adhering to treatments. With technological advances, it remains important to investigate the potential of health information technology (HIT) in supporting medication adherence among them. OBJECTIVES This review investigates the role of HIT in supporting adherence to medication and therapies among patients with memory issues. It also captures the factors that impact technology adherence interventions. METHODS We searched the literature for relevant publications published until March 15, 2023, using technology to support adherence among patients with memory issues (dementia, Alzheimer's, amnesia, mild cognitive impairment, memory loss, etc.). The review was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We conducted a quality assessment of the papers following the Mixed Methods Appraisal Tool. RESULTS Fifteen studies were included after carefully reviewing the 3,773 articles in the search. Methodological quality, as appraised, ranged from 80 to 100% with eight studies rated 100%. The studies overall did not have a high risk of bias. Thus, all of the 15 studies were included. Technologies investigated were classified into four groups based on their impact: therapeutic patient education, simplifying treatment regimens, early follow-up visits and short-term treatment goals, and reminder programs. Different technologies were used (automatic drug dispensers or boxes, mobile health-based interventions, game-based interventions, e-health-based interventions, patient portals, and virtual reality). The factors impacting patients' adherence to technology-based treatment and medication were clustered into human-computer interaction and integration challenges. CONCLUSION This study contributes to the literature by classifying the technologies that supported medication adherence among patients with memory issues in four groups. It also explores and presents the possible limitations of existing solutions to drive future research in supporting care for people with memory disorders.
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Affiliation(s)
- Safa Elkefi
- School of Nursing, Columbia University Medical School, Columbia University, United States
- Langone health, New York University Medical School, New York University, New York, United States
| | - Saul Blecker
- Langone health, New York University Medical School, New York University, New York, United States
| | - Yuval Bitan
- Department of Health Policy and Management, Ben-Guiron University of the Negev, Beer Sheva, Israel
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Faisal S, Samoth D, Aslam Y, Patel H, Park S, Baby B, Patel T. Key Features of Smart Medication Adherence Products: Updated Scoping Review. JMIR Aging 2023; 6:e50990. [PMID: 38113067 PMCID: PMC10762620 DOI: 10.2196/50990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/25/2023] [Accepted: 11/19/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Older adults often face challenges in self-managing their medication owing to physical and cognitive limitations, complex medication regimens, and packaging of medications. Emerging smart medication dispensing and adherence products (SMAPs) offer the options of automated dispensing, tracking medication intake in real time, and reminders and notifications. A 2021 review identified 51 SMAPs owing to the rapid influx of digital technology; an update to this review is required. OBJECTIVE This review aims to identify new products and summarize and compare the key features of SMAPs. METHODS Gray and published literature and videos were searched using Google, YouTube, PubMed, Embase, and Scopus. The first 10 pages of Google and the first 100 results of YouTube were screened using 4 and 5 keyword searches, respectively. SMAPs were included if they were able to store and allowed for the dispensation of medications, tracked real-time medication intake data, and could automatically analyze data. Products were excluded if they were stand-alone software applications, not marketed in English, not for in-home use, or only used in clinical trials. In total, 5 researchers independently screened and extracted the data. RESULTS This review identified 114 SMAPs, including 80 (70.2%) marketed and 34 (29.8%) prototypes, grouped into 15 types. Among the marketed products, 68% (54/80) were available for consumer purchase. Of these products, 26% (14/54) were available worldwide and 78% (42/54) were available in North America. There was variability in the hardware, software, data collection and management features, and cost of the products. Examples of hardware features include battery life, medication storage capacity, availability of types and number of alarms, locking features, and additional technology required for use of the product, whereas software features included reminder and notification capabilities and availability of manufacturer support. Data capture methods included the availability of sensors to record the use of the product and data-syncing capabilities with cloud storage with short-range communications. Data were accessible to users via mobile apps or web-based portals. Some SMAPs provided data security assurance with secure log-ins (use of personal identification numbers or facial recognition), whereas other SMAPs provided data through registered email addresses. Although some SMAPs were available at set prices or free of cost to end users, the cost of other products varied based on availability, shipping fees, and subscription fees. CONCLUSIONS An expanding market for SMAPs with features specific to at-home patient use is emerging. Health care professionals can use these features to select and suggest products that meet their patients' unique requirements.
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Affiliation(s)
- Sadaf Faisal
- School of Pharmacy, University of Waterloo, Kitchener, ON, Canada
| | - Devine Samoth
- School of Pharmacy, University of Waterloo, Kitchener, ON, Canada
| | - Yusra Aslam
- School of Pharmacy, University of Waterloo, Kitchener, ON, Canada
| | - Hawa Patel
- School of Pharmacy, University of Waterloo, Kitchener, ON, Canada
| | - SooMin Park
- School of Pharmacy, University of Waterloo, Kitchener, ON, Canada
| | - Bincy Baby
- School of Pharmacy, University of Waterloo, Kitchener, ON, Canada
| | - Tejal Patel
- School of Pharmacy, University of Waterloo, Kitchener, ON, Canada
- Schlegel - University of Waterloo Research Institute of Aging, Waterloo, ON, Canada
- Centre for Family Medicine Family Health Team, Kitchener, ON, Canada
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Chalasani SH, Syed J, Ramesh M, Patil V, Pramod Kumar T. Artificial intelligence in the field of pharmacy practice: A literature review. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 12:100346. [PMID: 37885437 PMCID: PMC10598710 DOI: 10.1016/j.rcsop.2023.100346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 10/06/2023] [Accepted: 10/07/2023] [Indexed: 10/28/2023] Open
Abstract
Artificial intelligence (AI) is a transformative technology used in various industrial sectors including healthcare. In pharmacy practice, AI has the potential to significantly improve medication management and patient care. This review explores various AI applications in the field of pharmacy practice. The incorporation of AI technologies provides pharmacists with tools and systems that help them make accurate and evidence-based clinical decisions. By using AI algorithms and Machine Learning, pharmacists can analyze a large volume of patient data, including medical records, laboratory results, and medication profiles, aiding them in identifying potential drug-drug interactions, assessing the safety and efficacy of medicines, and making informed recommendations tailored to individual patient requirements. Various AI models have been developed to predict and detect adverse drug events, assist clinical decision support systems with medication-related decisions, automate dispensing processes in community pharmacies, optimize medication dosages, detect drug-drug interactions, improve adherence through smart technologies, detect and prevent medication errors, provide medication therapy management services, and support telemedicine initiatives. By incorporating AI into clinical practice, health care professionals can augment their decision-making processes and provide patients with personalized care. AI allows for greater collaboration between different healthcare services provided to a single patient. For patients, AI may be a useful tool for providing guidance on how and when to take a medication, aiding in patient education, and promoting medication adherence and AI may be used to know how and where to obtain the most cost-effective healthcare and how best to communicate with healthcare professionals, optimize the health monitoring using wearables devices, provide everyday lifestyle and health guidance, and integrate diet and exercise.
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Affiliation(s)
- Sri Harsha Chalasani
- Dept. of Pharmacy Practice, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysuru 15, Karnataka, India
| | - Jehath Syed
- Dept. of Pharmacy Practice, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysuru 15, Karnataka, India
| | - Madhan Ramesh
- Dept. of Pharmacy Practice, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysuru 15, Karnataka, India
| | - Vikram Patil
- Dept. of Radiology, JSS Medical College & Hospital, JSS Academy of Higher Education & Research, Mysuru 15, Karnataka, India
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Sinnappah KA, Hughes DA, Stocker SL, Vrijens B, Aronson JK, Wright DFB. A framework for understanding sources of bias in medication adherence research. Br J Clin Pharmacol 2023; 89:3444-3453. [PMID: 37496213 DOI: 10.1111/bcp.15863] [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: 04/12/2023] [Revised: 07/07/2023] [Accepted: 07/23/2023] [Indexed: 07/28/2023] Open
Abstract
The sources of bias in medication adherence research have not been comprehensively explored. We aimed to identify biases expected to affect adherence research and to develop a framework for mapping these onto the phases of adherence (initiation, implementation and discontinuation). A literature search was conducted, key papers were reviewed and a Catalogue of Bias was consulted. The specific biases related to adherence measurement and metrics were mapped onto the phases of adherence using a tabular matrix. Twenty-three biases were identified, of which 11 were specifically relevant to adherence measures and metrics. The mapping framework showed differences in the numbers and types of biases associated with each measure and metric while highlighting those common to many adherence study designs (e.g., unacceptability bias and apprehension bias). The framework will inform the design of adherence studies and the development of risk of bias tools for adherence research.
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Affiliation(s)
| | - Dyfrig A Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Sophie L Stocker
- Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Bernard Vrijens
- AARDEX Group, Seraing, Belgium
- Liège University, Liège, Belgium
| | - Jeffrey K Aronson
- Centre for Evidence-based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Niazi SK. The Coming of Age of AI/ML in Drug Discovery, Development, Clinical Testing, and Manufacturing: The FDA Perspectives. Drug Des Devel Ther 2023; 17:2691-2725. [PMID: 37701048 PMCID: PMC10493153 DOI: 10.2147/dddt.s424991] [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: 06/28/2023] [Accepted: 08/24/2023] [Indexed: 09/14/2023] Open
Abstract
Artificial intelligence (AI) and machine learning (ML) represent significant advancements in computing, building on technologies that humanity has developed over millions of years-from the abacus to quantum computers. These tools have reached a pivotal moment in their development. In 2021 alone, the U.S. Food and Drug Administration (FDA) received over 100 product registration submissions that heavily relied on AI/ML for applications such as monitoring and improving human performance in compiling dossiers. To ensure the safe and effective use of AI/ML in drug discovery and manufacturing, the FDA and numerous other U.S. federal agencies have issued continuously updated, stringent guidelines. Intriguingly, these guidelines are often generated or updated with the aid of AI/ML tools themselves. The overarching goal is to expedite drug discovery, enhance the safety profiles of existing drugs, introduce novel treatment modalities, and improve manufacturing compliance and robustness. Recent FDA publications offer an encouraging outlook on the potential of these tools, emphasizing the need for their careful deployment. This has expanded market opportunities for retraining personnel handling these technologies and enabled innovative applications in emerging therapies such as gene editing, CRISPR-Cas9, CAR-T cells, mRNA-based treatments, and personalized medicine. In summary, the maturation of AI/ML technologies is a testament to human ingenuity. Far from being autonomous entities, these are tools created by and for humans designed to solve complex problems now and in the future. This paper aims to present the status of these technologies, along with examples of their present and future applications.
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Blair CS, Gandhi M, Shoptaw S, Blades C, Clark JL. Contingency Management for Integrated Harm Reduction Among Men Who Have Sex with Men Who Use Methamphetamine in Los Angeles: A Pilot Assessment. AIDS Behav 2023; 27:1962-1971. [PMID: 36414775 PMCID: PMC10152513 DOI: 10.1007/s10461-022-03929-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2022] [Indexed: 11/24/2022]
Abstract
Methamphetamine (MA) use is associated with HIV transmission among men who have sex with men (MSM) and lapses in medication adherence. Contingency Management (CM) is effective in reducing MA use, but studies of CM to support adherence to HIV prevention or treatment are limited. We conducted a pilot trial of a CM intervention to reduce MA use and improve PrEP/ART adherence among MSM prescribed a tenofovir (TFV)-based regimen for HIV prevention or treatment. Participants were randomly assigned to receive escalating incentives for either MA abstinence or TFV adherence (based on point-of-care urine testing), and to a monitoring schedule of either 2 or 3 visits/week for 4 weeks. 19 MSM were randomized to either CM for MA use or CM for PrEP/ART adherence (median age: 38; IQR: 28-46) and 15 were living with HIV. Participants attended 95.7% (67/70) of scheduled visits in the 2x/week arm and 74.8% (74/99) in the 3x/week arm. TFV adherence was higher among participants in the TFV adherence arm with 93.5% (n = 72/77) of urine samples positive for TFV, compared to 76.6% (n = 49/64) in the MA abstinence arm (p = 0.007). Participants in the MA abstinence arm had more urine samples negative for MA metabolites (20.3%, n = 13/64) than those receiving CM for TFV adherence (6.5%, n = 5/77; p = 0.021). A CM model for MA abstinence and PrEP/ART adherence using twice-weekly visits and urine testing for MA and TFV for MSM who use MA is feasible and potentially effective as an integrated harm reduction strategy.
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Affiliation(s)
- Cheríe S Blair
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, 10833 LeConte Avenue, CHS 52-215, 90095, Los Angeles, CA, USA.
| | - Monica Gandhi
- Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, CA, USA
| | - Steven Shoptaw
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Christopher Blades
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jesse L Clark
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, 10833 LeConte Avenue, CHS 52-215, 90095, Los Angeles, CA, USA
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Walton KM, Herrmann ES. Medication Adherence in Tobacco Cessation Clinical Trials. ADDICTION NEUROSCIENCE 2023; 6:100069. [PMID: 36817408 PMCID: PMC9934057 DOI: 10.1016/j.addicn.2023.100069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Adherence is a critical mediator of treatment outcome across health conditions and low rates of adherence undermine success in smoking cessation treatment. This narrative review provides an overview of different techniques that can be used to measure adherence to smoking cessation treatments and outlines strategies to address treatment adherence. Techniques to measure adherence include conducting pill counts, collecting self-reports of adherence, directly observed therapy, biochemical verification methods, and electronic data collection via medication events monitoring systems. Techniques examined for increasing tobacco cessation treatment adherence include counseling, automated adherence calls, feedback from electronic monitors, contingency management and directly observed therapy. Adherence monitoring and optimization should be a standard component of smoking cessation treatment research.
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Affiliation(s)
- Kevin M. Walton
- Division of Therapeutics and Medical Consequences, National Institute on Drug Abuse, NIH
| | - Evan S. Herrmann
- Division of Therapeutics and Medical Consequences, National Institute on Drug Abuse, NIH
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Rodrigues R, Varghese SS, Mahrous M, Ananthaneni Kumar A, Ahmed MN, D'Souza G. Feasibility and acceptability pilot of video-based direct observed treatment (vDOT) for supporting antitubercular treatment in South India: a cohort study. BMJ Open 2023; 13:e065878. [PMID: 37247959 DOI: 10.1136/bmjopen-2022-065878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
OBJECTIVES The objective of this study was to assess the feasibility and acceptability of video-based anti-tuberculosis (TB) treatment adherence support in patients with TB (PwTB) in South India. DESIGN An exploratory cohort. SETTING Participants were recruited at the TB treatment centre (direct observed treatment short centre) of a tertiary-level teaching facility in Bangalore, Karnataka, South India. PARTICIPANTS The study enrolled 25 PwTB, with replacement. Adult PwTB who were on drug-sensitive treatment regimens were included, while those who had drug resistant TB were excluded from the study. INTERVENTION Participants received scheduled adherence reminders and were trained to videorecord themselves swallowing their medication via a mobile application. The application was automated to submit these videos for evaluation. Participants were followed up monthly till treatment completion or withdrawal. OUTCOME MEASURES Adherence rate and acceptability of video-based directly observed treatment (vDOT). RESULTS The mean±SD age of the participants was 33±14 years, majority were females (16, 64%), residing in urban areas (24,96%), married (17, 68%) and had access to smart phones (23,92%). A total of 3193 person days of follow-up was completed; of the videos submitted within the first 6 months of enrollment (2501), 94% (2354/2501) were considered 'acceptable' and 16 (64%) participants were optimally adherent (ie, ≥80%). Participant videos improved in quality and a higher proportion met acceptability criteria over time. Twenty-one (84%) participants stated that they found the application easy to learn; 13 (52%) preferred vDOT over DOT. Mixed model logistic regression showed that those who are married are more likely have daily adherence to anti-TB treatment. CONCLUSION Video-based mobile phone interventions are acceptable to PwTB and the ease of using the application increases with time. To provide patient-centred care, vDOT is a promising option that can be offered to patients for treatment support and adherence monitoring.
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Affiliation(s)
- Rashmi Rodrigues
- Community Health, St John's National Academy of Health Sciences, Bangalore, Karnataka, India
- Global Public Health, Karolinska Institute, Stockholm, Sweden
- Intermidiate Fellow, Clinical and Public Health, DBT/ Wellcome Trust India Alliance, Hyderabad, India
| | - Suman Sarah Varghese
- St. John's Research Institute, St John's National Academy of Health Sciences, Bangalore, Karnataka, India
| | | | - Anil Ananthaneni Kumar
- St. John's Research Institute, St John's National Academy of Health Sciences, Bangalore, Karnataka, India
| | - Mohammed Naseer Ahmed
- St. John's Research Institute, St John's National Academy of Health Sciences, Bangalore, Karnataka, India
- Blackpool Teaching Hospital, NHS trust, Blackpool, UK
| | - George D'Souza
- Pulmonary Medicine, St John's National Academy of Health Sciences, Bangalore, Karnataka, India
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Lindsey JC, Hudgens M, Gaur AH, Horvath KJ, Dallas R, Heckman B, Johnson MM, Amico KR. Electronic Dose Monitoring Device Patterns in Youth Living With HIV Enrolled in an Adherence Intervention Clinical Trial. J Acquir Immune Defic Syndr 2023; 92:231-241. [PMID: 36730762 PMCID: PMC9928806 DOI: 10.1097/qai.0000000000003126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 10/24/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Youth living with HIV in the US have low rates of viral suppression, in part because of challenges with antiretroviral therapy adherence. METHODS Daily dosing in the Adolescent Medicine Trials Network for HIV/AIDS Interventions 152 study, a randomized controlled trial of a 12-week adherence intervention (triggered escalating real-time adherence intervention) for viremic youth, compared with standard of care (SOC), was measured by electronic dose monitoring (EDM) throughout 48 weeks of follow-up. EDM data collected over the first 24 weeks were used to characterize patterns of antiretroviral therapy adherence with group-based trajectory models. RESULTS Four trajectory groups were identified among the 85 participants included in the analysis during the intervention phase of the study: (Worst) no interaction with EDM, (Declining) initially moderate EDM-based adherence followed by steep declines, (Good) initially high EDM-based adherence with modest declines, and (Best) consistently high EDM-based adherence. Being in the SOC arm, not being in school, higher evasiveness and panic decision-making scores, and lower adherence motivation were associated with higher odds of being in a worse trajectory group ( P < 0.05). A general decline in dosing was observed in the 12 weeks postintervention, when all participants were managed using SOC. CONCLUSIONS Use of group-based trajectory models allowed a more nuanced understanding of EDM-based adherence over time compared with collapsed summary measures. In addition to the study intervention, other factors influencing EDM-based adherence included being in school, decision-making styles, and adherence-related motivation. This information can be used to design better intervention services for youth living with HIV.
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Affiliation(s)
- Jane C. Lindsey
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA, US
| | - Michael Hudgens
- University of North Carolina at Chapel Hill, Gillings School of Public Health, Department of Biostatistics, Collaborative Studies Coordinating Center, Chapel Hill, NC, US
| | - Aditya H. Gaur
- St. Jude Children’s Research Hospital, Department of Infectious Diseases, Memphis, TN, US
| | | | - Ronald Dallas
- St. Jude Children’s Research Hospital, Department of Infectious Diseases, Memphis, TN, US
| | - Barbara Heckman
- Frontier Science and Technology Research Foundation, Inc., Amherst, NY, US
| | - Megan Mueller Johnson
- University of Michigan, School of Public Health, Department of Health Behavior and Health Education, Ann Arbor, MI, US
| | - K Rivet Amico
- University of Michigan, School of Public Health, Department of Health Behavior and Health Education, Ann Arbor, MI, US
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Exploring the Value of Real-Time Medication Adherence Monitoring: A Qualitative Study. PHARMACY 2023; 11:pharmacy11010018. [PMID: 36827656 PMCID: PMC9967842 DOI: 10.3390/pharmacy11010018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/11/2023] [Accepted: 01/14/2023] [Indexed: 01/19/2023] Open
Abstract
Smart adherence products enable the monitoring of medication intake in real-time. However, the value of real-time medication intake monitoring to different stakeholders such as patients, their caregivers, clinicians, and insurers is not elucidated. The aim of this study was to explore the value different stakeholders place on the availability of smart adherence products and access to real-time medication intake data. A qualitative study design using semi-structured one-on-one virtual interviews was utilized. Schwartz's theory of values provided the foundation for the interview questions, data were analyzed using Braun and Clark's thematic analysis framework, and findings were mapped back to the constructs of Schwartz's theory of values. A total of 31 interviews with patients, caregivers, healthcare providers, and representatives of private or public insurance providers were conducted. Three themes and ten subthemes were identified. Themes included perceptions of integrating smart medication adherence technologies and real-time monitoring, technology adoption factors and data management. Stakeholders place different values based on the motivators and goals that can drive product use for daily medication management. Stakeholders valued the availability of real-time medication taking data that allow clinicians to make timely data-driven recommendations to their patients that may improve medication management for patients and reduce the caregiver burden.
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Takahashi EA, Schwamm LH, Adeoye OM, Alabi O, Jahangir E, Misra S, Still CH. An Overview of Telehealth in the Management of Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation 2022; 146:e558-e568. [PMID: 36373541 DOI: 10.1161/cir.0000000000001107] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Telehealth enables the remote delivery of health care through telecommunication technologies and has substantially affected the evolving medical landscape. The COVID-19 pandemic accelerated the utilization of telehealth as health care professionals were forced to limit face-to-face in-person visits. It has been shown that information delivery, diagnosis, disease monitoring, and follow-up care can be conducted remotely, resulting in considerable changes specific to cardiovascular disease management. Despite increasing telehealth utilization, several factors such as technological infrastructure, reimbursement, and limited patient digital literacy can hinder the adoption of remote care. This scientific statement reviews definitions pertinent to telehealth discussions, summarizes the effect of telehealth utilization on cardiovascular and peripheral vascular disease care, and identifies obstacles to the adoption of telehealth that need to be addressed to improve health care accessibility and equity.
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Chettati M, Bouchemla N, Fadili W, Laouad I. Utilisation de l’application mobile TestObs pour l’évaluation de l’observance thérapeutique dans une population d’hémodialysés chroniques : modèle de monitoring technologique de l’adhérence au traitement et ses facteurs déterminants. Nephrol Ther 2022; 18:557-564. [DOI: 10.1016/j.nephro.2022.07.397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 11/06/2022]
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Giedraitiene N, Taluntiene V, Kaubrys G. Relationship between cognition and treatment adherence to disease-modifying therapy in multiple sclerosis: a prospective, cross-sectional study. Sci Rep 2022; 12:12447. [PMID: 35859004 PMCID: PMC9300629 DOI: 10.1038/s41598-022-16790-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 07/15/2022] [Indexed: 11/09/2022] Open
Abstract
Less than half of patients with chronic diseases, including multiple sclerosis (MS), adhere to their prescribed medications. Treatment selection is essential for patient adherence. The aim of this study was to explore the potential factors influencing nonadherence to disease-modifying therapies (DMTs) in MS. This prospective, cross-sectional study was performed at the Multiple Sclerosis Center between 2018 and 2021. In total, 85 patients were eligible for final analysis. Forty-one patient (48.2%) with MS were non-adherent to DMT. Male sex, oral administration of drugs, and longer treatment duration were associated with nonadherence. The mean Expanded Disability Status Scale score did not differ between the adherent and non-adherent patients (p > 0.05). Patients with a higher score on the Symbol Digit Modalities Test, who were receiving self-injection therapy, had shorter treatment duration, and higher disability, were more likely to be adherent to DMT than those without. To minimize nonadherence in patients with MS, the patient's information processing speed should be considered before DMT initiation, and appropriate treatment options should be discussed.
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Affiliation(s)
- N Giedraitiene
- Clinic of Neurology and Neurosurgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
| | - V Taluntiene
- Clinic of Neurology and Neurosurgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - G Kaubrys
- Clinic of Neurology and Neurosurgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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