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Houghton DC, Merritt CR, Miller SN, Mitchell JM, Parker D, Hommel JD, Cunningham KA, Wilkes DM. Electronic Real-Time Monitoring Reveals Limited Adherence to Long-Term Opioid Prescriptions in Pain Patients. J Pain Res 2024; 17:1815-1827. [PMID: 38799276 PMCID: PMC11127646 DOI: 10.2147/jpr.s436898] [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] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 04/15/2024] [Indexed: 05/29/2024] Open
Abstract
Background Pain management physicians are increasingly focused on limiting prescription opioid abuse, yet existing tools for monitoring adherence have limited accuracy. Medication event monitoring system (MEMS) is an emerging technology for tracking medication usage in real-time but has not been tested in chronic pain patients on long-term opioid regimens. Objective We conducted a pilot clinical trial to investigate the utility of MEMS for monitoring opioid adherence and compared to traditional methods including self-report diaries, urine drug screen (UDS), and physicians' opinions. Methods Opioid-maintained chronic pain patients were recruited from a pain management clinic. Participants (n=28) were randomly assigned to either receive MEMS bottles containing their opioid medication for a 90-day period or to continue using standard medication bottles. MEMS bottles were configured to record and timestamp all bottle openings and the number of pills that were removed from the bottle (via measurement of weight change). Results Participants who received MEMS demonstrated highly heterogenous dosing patterns, with a substantial number of patients rapidly removing excessive amounts of medication and/or "stockpiling" medication. By comparison, physicians rated all participants as either "totally compliant" or "mostly compliant". UDS results did not reveal any illicit drug use, but 25% of participants (n=7) tested negative for their prescribed opioid metabolite. MEMS data did not correlate with physician-rated adherence (P=0.24) and UDS results (P=0.77). MEMS data consistently revealed greater non-adherence than self-report data (P<0.001). Conclusion These results highlight the limits in our understanding of naturalistic patterns of daily opioid use in chronic pain patients as well as support the use of MEMS for detecting potential misuse as compared to routine adherence monitoring methods. Future research directions include the need to determine how MEMS could be used to improve patient outcomes, minimize harm, and aid in clinical decision-making. Trial Registration This study was preregistered on ClinicalTrials.gov (NCT03752411).
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Affiliation(s)
- David C Houghton
- Center for Addiction Sciences and Therapeutics, University of Texas Medical Branch, Galveston, TX, USA
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, TX, USA
| | - Christina R Merritt
- Center for Addiction Sciences and Therapeutics, University of Texas Medical Branch, Galveston, TX, USA
- Department of Pharmacology and Toxicology, University of Texas Medical Branch, Galveston, TX, USA
| | - Sierra N Miller
- Center for Addiction Sciences and Therapeutics, University of Texas Medical Branch, Galveston, TX, USA
| | - Jasmine M Mitchell
- Department of Family and Community Medicine, UT McGovern Medical School, Houston, TX, USA
| | - David Parker
- Center for Addiction Sciences and Therapeutics, University of Texas Medical Branch, Galveston, TX, USA
| | - Jonathan D Hommel
- Center for Addiction Sciences and Therapeutics, University of Texas Medical Branch, Galveston, TX, USA
- Department of Pharmacology and Toxicology, University of Texas Medical Branch, Galveston, TX, USA
| | - Kathryn A Cunningham
- Center for Addiction Sciences and Therapeutics, University of Texas Medical Branch, Galveston, TX, USA
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, TX, USA
- Department of Pharmacology and Toxicology, University of Texas Medical Branch, Galveston, TX, USA
| | - Denise M Wilkes
- Center for Addiction Sciences and Therapeutics, University of Texas Medical Branch, Galveston, TX, USA
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, TX, USA
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Chai PR, Kaithamattam JJ, Chung M, Tom JJ, Goodman GR, Hasdianda MA, Carnes TC, Vaduganathan M, Scirica BM, Schnipper JL. Formative Perceptions of a Digital Pill System to Measure Adherence to Heart Failure Pharmacotherapy: Mixed Methods Study. JMIR Cardio 2024; 8:e48971. [PMID: 38358783 PMCID: PMC10905352 DOI: 10.2196/48971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 10/19/2023] [Accepted: 12/22/2023] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Heart failure (HF) affects 6.2 million Americans and is a leading cause of hospitalization. The mainstay of the management of HF is adherence to pharmacotherapy. Despite the effectiveness of HF pharmacotherapy, effectiveness is closely linked to adherence. Measuring adherence to HF pharmacotherapy is difficult; most clinical measures use indirect strategies such as calculating pharmacy refill data or using self-report. While helpful in guiding treatment adjustments, indirect measures of adherence may miss the detection of suboptimal adherence and co-occurring structural barriers associated with nonadherence. Digital pill systems (DPSs), which use an ingestible radiofrequency emitter to directly measure medication ingestions in real-time, represent a strategy for measuring and responding to nonadherence in the context of HF pharmacotherapy. Previous work has demonstrated the feasibility of using DPSs to measure adherence in other chronic diseases, but this strategy has yet to be leveraged for individuals with HF. OBJECTIVE We aim to explore through qualitative interviews the facilitators and barriers to using DPS technology to monitor pharmacotherapy adherence among patients with HF. METHODS We conducted individual, semistructured qualitative interviews and quantitative assessments between April and August 2022. A total of 20 patients with HF who were admitted to the general medical or cardiology service at an urban quaternary care hospital participated in this study. Participants completed a qualitative interview exploring the overall acceptability of and willingness to use DPS technology for adherence monitoring and perceived barriers to DPS use. Quantitative assessments evaluated HF history, existing medication adherence strategies, and attitudes toward technology. We analyzed qualitative data using applied thematic analysis and NVivo software (QSR International). RESULTS Most participants (12/20, 60%) in qualitative interviews reported a willingness to use the DPS to measure HF medication adherence. Overall, the DPS was viewed as useful for increasing accountability and reinforcing adherence behaviors. Perceived barriers included technological issues, a lack of need, additional costs, and privacy concerns. Most were open to sharing adherence data with providers to bolster clinical care and decision-making. Reminder messages following detected nonadherence were perceived as a key feature, and customization was desired. Suggested improvements are primarily related to the design and usability of the Reader (a wearable device). CONCLUSIONS Overall, individuals with HF perceived the DPS to be an acceptable and useful tool for measuring medication adherence. Accurate, real-time ingestion data can guide adherence counseling to optimize adherence management and inform tailored behavioral interventions to support adherence among patients with HF.
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Affiliation(s)
- Peter R Chai
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, United States
- The Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, United States
- The Fenway Institute, Boston, MA, United States
| | - Jenson J Kaithamattam
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Michelle Chung
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Jeremiah J Tom
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Georgia R Goodman
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States
- The Fenway Institute, Boston, MA, United States
| | | | | | - Muthiah Vaduganathan
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Benjamin M Scirica
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Jeffrey L Schnipper
- Division of Hospital Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States
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Goodman GR, Carnes TC, Albrechta H, Alpert P, Hokayem J, Goldfine C, Lee JS, Boyer EW, Rosen R, Mayer KH, O'Cleirigh C, Chai PR. Real-World Implementation Challenges Associated with a Digital Pill System to Measure Adherence to HIV Pre-Exposure Prophylaxis from Two Studies of Men Who Have Sex With Men. PROCEEDINGS OF THE ... ANNUAL HAWAII INTERNATIONAL CONFERENCE ON SYSTEM SCIENCES. ANNUAL HAWAII INTERNATIONAL CONFERENCE ON SYSTEM SCIENCES 2024; 57:3211-3221. [PMID: 38213843 PMCID: PMC10783042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
Once-daily oral pre-exposure prophylaxis (PrEP) is highly effective for HIV prevention, but its efficacy is dependent on adherence, which can be challenging for men who have sex with men (MSM) with substance use. Digital pill systems (DPS) represent a novel tool for directly measuring adherence through ingestible radiofrequency sensors that confirm ingestions in real-time. We examined operational challenges across two studies involving DPS to measure PrEP adherence. While most participants successfully operated the system, a number of technological and sociobehavioral challenges requiring intervention were identified across both studies. Technological issues were both system- and participant-related, and were primarily addressed with technical updates and participant re-education, while sociobehavioral issues, including health and housing changes and issues with technology access, warranted innovative solutions. Future research leveraging DPS technology should develop robust supportive infrastructure and mitigation procedures to promptly identify and resolve operational issues to optimize the potential benefits of DPS use.
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Affiliation(s)
| | | | | | | | | | | | - Jasper S Lee
- Department of Psychiatry, Massachusetts General Hospital
| | - Edward W Boyer
- Department of Emergency Medicine, Ohio State University, Wexner Medical Center
| | | | | | | | - Peter R Chai
- Department of Emergency Medicine, Brigham and Women's Hospital
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Armstrong M, Groner JI, Samora J, Olbrecht VA, Tram NK, Noffsinger D, Boyer EW, Xiang H. Impact of opioid law on prescriptions and satisfaction of pediatric burn and orthopedic patients: An epidemiologic study. PLoS One 2023; 18:e0294279. [PMID: 37972014 PMCID: PMC10653505 DOI: 10.1371/journal.pone.0294279] [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: 05/15/2023] [Accepted: 10/30/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVES The objective of this study was to determine the reduction in prescribed opioid pain dosage units to pediatric patients experiencing acute pain and to assess patient satisfaction with pain control 90-day post discharge following the 2017 Ohio opioid prescribing cap law. METHODS The retrospective chart review included 960 pediatric (age 0-18 years) burn injury and knee arthroscopy patients treated between August 1, 2015-August 31, 2019. Prospectively, legal guardians completed a survey for a convenience sample of 50 patients. Opioid medications (days and morphine milligram equivalents (MMEs)/kg) prescribed at discharge before and after the Ohio law implementation were collected. Guardians reported experience and satisfaction with their child's opioid prescription at 90-days post discharge. RESULTS From pre-law to post-law, there was a significant decrease (p<0.001) within the burn and knee cohorts in the median days (1.7 to 1.0 and 5.0 to 3.8, respectively) and median total MMEs prescribed (15.0 to 2.5 and 150.0 to 90.0, respectively). An interrupted time series analysis revealed a statistically significant decrease in MMEs/kg and days prescribed at discharge when the 2017 Ohio opioid prescription law went into effect, with an abrupt level change. Prospectively, more than half of participants were satisfied (72% burn and 68% knee) with their pain control and felt they received the right amount of medication (84% burn and 56% knee). Inpatient opioid use was not changed pre- and post-law. CONCLUSIONS Discharge opioids prescribed for pediatric burn and knee arthroscopy procedures has decreased from 2015-2019. Caregivers varied greatly in their satisfaction with pain control and the amount of opioid prescribed.
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Affiliation(s)
- Megan Armstrong
- Center for Pediatric Trauma Research, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, United States of America
- Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, United States of America
| | - Jonathan I. Groner
- Center for Pediatric Trauma Research, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, United States of America
- Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, United States of America
- Department of Pediatric Surgery, Nationwide Children’s Hospital, Columbus, OH, United States of America
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Julie Samora
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States of America
- Department of Orthopedics, Nationwide Children’s Hospital, Columbus, OH, United States of America
| | - Vanessa A. Olbrecht
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States of America
- Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, Columbus, OH, United States of America
| | - Nguyen K. Tram
- Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, Columbus, OH, United States of America
| | - Dana Noffsinger
- Center for Pediatric Trauma Research, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, United States of America
- Department of Pediatric Surgery, Nationwide Children’s Hospital, Columbus, OH, United States of America
| | - Edward W. Boyer
- Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Henry Xiang
- Center for Pediatric Trauma Research, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, United States of America
- Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, United States of America
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States of America
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5
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Rigatti M, Chapman B, Chai PR, Smelson D, Babu K, Carreiro S. Digital Biomarker Applications Across the Spectrum of Opioid Use Disorder. COGENT MENTAL HEALTH 2023; 2:2240375. [PMID: 37546179 PMCID: PMC10399596 DOI: 10.1080/28324765.2023.2240375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/17/2023] [Indexed: 08/08/2023]
Abstract
Opioid use disorder (OUD) is one of the most pressing public health problems of the past decade, with over eighty thousand overdose related deaths in 2021 alone. Digital technologies to measure and respond to disease states encompass both on- and off-body sensors. Such devices can be used to detect and monitor end-user physiologic or behavioral measurements (i.e. digital biomarkers) that correlate with events of interest, health, or pathology. Recent work has demonstrated the potential of digital biomarkers to be used as a tools in the prevention, risk mitigation, and treatment of opioid use disorder (OUD). Multiple physiologic adaptations occur over the course of opioid use, and represent potential targets for digital biomarker based monitoring strategies. This review explores the current evidence (and potential) for digital biomarkers monitoring across the spectrum of opioid use. Technologies to detect opioid administration, withdrawal, hyperalgesia and overdose will be reviewed. Driven by empirically derived algorithms, these technologies have important implications for supporting the safe prescribing of opioids, reducing harm in active opioid users, and supporting those in recovery from OUD.
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Affiliation(s)
- Marc Rigatti
- Department of Emergency Medicine, UMass Chan Medical School, Worcester, MA, USA
| | - Brittany Chapman
- Department of Emergency Medicine, UMass Chan Medical School, Worcester, MA, USA
| | - Peter R Chai
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - David Smelson
- Department of Psychiatry, UMass Chan Medical School, Worcester, MA, USA
| | - Kavita Babu
- Department of Emergency Medicine, UMass Chan Medical School, Worcester, MA, USA
| | - Stephanie Carreiro
- Department of Emergency Medicine, UMass Chan Medical School, Worcester, MA, USA
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6
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Gleich B, Schmale I, Nielsen T, Rahmer J. Miniature magneto-mechanical resonators for wireless tracking and sensing. Science 2023; 380:966-971. [PMID: 37262171 DOI: 10.1126/science.adf5451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 05/03/2023] [Indexed: 06/03/2023]
Abstract
Sensor miniaturization enables applications such as minimally invasive medical procedures or patient monitoring by providing process feedback in situ. Ideally, miniature sensors should be wireless, inexpensive, and allow for remote detection over sufficient distance by an affordable detection system. We analyze the signal strength of wireless sensors theoretically and derive a simple design of high-signal resonant magneto-mechanical sensors featuring volumes below 1 cubic millimeter. As examples, we demonstrate real-time tracking of position and attitude of a flying bee, navigation of a biopsy needle, tracking of a free-flowing marker, and sensing of pressure and temperature, all in unshielded environments. The achieved sensor size, measurement accuracy, and workspace of ~25 centimeters show the potential for a low-cost wireless tracking and sensing platform for medical and nonmedical applications.
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7
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Erras A, Shahrvini B, Weinreb RN, Baxter SL. Review of glaucoma medication adherence monitoring in the digital health era. Br J Ophthalmol 2023; 107:153-159. [PMID: 33858837 PMCID: PMC8517037 DOI: 10.1136/bjophthalmol-2020-317918] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 02/19/2021] [Accepted: 04/05/2021] [Indexed: 02/03/2023]
Abstract
Current glaucoma treatments aim to lower intraocular pressure, often with topical ocular hypotensive medications. Unfortunately, the effectiveness of these medications depends on sustained patient adherence to regimens which may involve instilling multiple medications several times daily. Patient adherence to glaucoma medications is often low. Recent innovations in digital sensor technologies have been leveraged to confirm eyedrop medication usage in real-time and relay this information back to providers. Some sensors have also been designed to deliver medication reminders and notifications as well as assist with correct eyedrop administration technique. Here, we review recent innovations targeted at improving glaucoma medication adherence and discuss their limitations.
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Affiliation(s)
- Alaa Erras
- Hamilton Glaucoma Center, Shiley Eye Institute and Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Bita Shahrvini
- Hamilton Glaucoma Center, Shiley Eye Institute and Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute and Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Sally L Baxter
- Hamilton Glaucoma Center, Shiley Eye Institute and Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA .,Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California, USA
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8
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Litvinova O, Klager E, Yeung AWK, Tzvetkov NT, Kimberger O, Kletecka-Pulker M, Willschke H, Atanasov AG. Bibliometric analysis and evidence of clinical efficacy and safety of digital pills. Front Pharmacol 2023; 14:1023250. [PMID: 36755951 PMCID: PMC9899979 DOI: 10.3389/fphar.2023.1023250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/12/2023] [Indexed: 01/24/2023] Open
Abstract
Objectives: Digital pills are new technologies that aim to improve healthcare by increasing medication adherence. The aim of the work was a bibliometric analysis of clinical studies of digital pills and an assessment of the level of evidence of their effectiveness, safety, and prospects for the future. Materials and Methods: The studies were conducted using online databases such as ClinicalTrials.gov, Dimensions, and Web of Science for the period January 2012 to July 2022. The VOSviewer tool for building and visualizing bibliometric networks was used. Results: Bibliometric analysis of the scientific literature revealed that over the past 10 years, the number of publications about digital pills has noticeably increased, which indicates the increasing importance of this field of knowledge. The leading positions in this area are occupied by scientists from the United States, the United Kingdom, and India. Sources of financial support for authors of publications in the field of digital pills are funds from leading developer companies, budget allocations, and funds from non-commercial organizations. Public-private partnerships are an important path to develop and implement digital pills. The four main clusters of digital pill studies were highlighted and visualized: efficacy and safety analysis for serious mental disorders; treatment and costs of tuberculosis therapy; features of the treatment of diabetes, cardiovascular diseases, and AIDS; and usage monitoring. Available publications demonstrate the efficacy potential and safety of digital pills. Nevertheless, the effects of digital pills have not yet been fully studied. Conclusion: Priority areas for future research are further randomized controlled clinical trials and meta-analyses, which are necessary for a high level (I level) of evidence for therapeutic applications of digital pills, as well as pharmacoeconomic studies.
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Affiliation(s)
- Olena Litvinova
- National University of Pharmacy of the Ministry of Health of Ukraine, Kharkiv, Ukraine,*Correspondence: Olena Litvinova, ; Atanas G. Atanasov,
| | - Elisabeth Klager
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
| | - Andy Wai Kan Yeung
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria,Division of Oral and Maxillofacial Radiology, Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Nikolay T. Tzvetkov
- Department of Biochemical Pharmacology and Drug Design, Bulgarian Academy of Sciences, Institute of Molecular Biology “Roumen Tsanev, Sofia, Bulgaria
| | - Oliver Kimberger
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria,Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Maria Kletecka-Pulker
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria,Institute for Ethics and Law in Medicine, University of Vienna, Vienna, Austria
| | - Harald Willschke
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria,Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Atanas G. Atanasov
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria,Institute of Genetics and Animal Biotechnology of the Polish Academy of Sciences, Jastrzebiec, Poland,*Correspondence: Olena Litvinova, ; Atanas G. Atanasov,
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Bischof JJ, Chai P, Mohamed Y, Padappayil R, Merchant RC, Boyer EW, Rosen R, Reyes-Gibby CC, Viamonte M, W Carrico A. MyTPill: study protocol for a cross-over randomised controlled trial comparing novel strategies to monitor antiretroviral adherence among HIV+ prescription opioid users. BMJ Open 2023; 13:e062805. [PMID: 36627157 PMCID: PMC9835860 DOI: 10.1136/bmjopen-2022-062805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Adherence to HIV antiretroviral therapy (ART) remains the cornerstone of HIV treatment. For individuals with suboptimal adherence, electronic adherence monitoring (EAM) technologies have become an important component of multimodal adherence support strategies. Most EAM technologies detect pillbox opening, and therefore, assume but cannot verify actual ingestion of oral medication. In contrast, a digital pill system (ID-capsule manufactured by etectRX, here named My/Treatment/Pill) measures directly ingestion of medications. Identifying the superior method to measure ART adherence would improve virological suppression by enabling the delivery of real-time interventions to support ART adherence, particularly in high-risk populations. METHODS AND ANALYSIS Cross-over, randomised trial with 1:1 variable block size randomisation comparing two EAM systems in prescription opioid-using HIV+patient on once daily oral bictegravir, emtricitabine and tenofovir alafenamide regimens and detectable viral load >200 copies/mL within 30 days of screening (n=80). The primary outcome is once daily ART adherence measurement efficacy as assessed by comparing the accuracy of each EAM system as measured by concordance of the respective EAM systems to dried blood spot ART concentrations. Secondary outcomes are the identification of multilevel factors that are prevalent in the target population most closely linked to ART non-adherence and EAM non-adherence. ETHICS AND DISSEMINATION This protocol was approved by the institutional review boards of participating sites (The Ohio State University, The Fenway Institute and the University of Miami). Data will be presented at scientific conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03978793.
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Affiliation(s)
- Jason J Bischof
- Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Peter Chai
- Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Rana Padappayil
- Internal Medicine, Monmouth Medical Center, Long Branch, New Jersey, USA
| | - Roland C Merchant
- Emergency Medicine, Mount Sinai School of Medicine, New York, New York, USA
| | - Edward W Boyer
- Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Emergency Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Rochelle Rosen
- Center for Behavioral and Preventive Medicine, Miriam Hospital, Providence, Rhode Island, USA
| | - Cielito C Reyes-Gibby
- Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael Viamonte
- Public Health Sciences, University of Miami, Coral Gables, Florida, USA
| | - Adam W Carrico
- Public Health Sciences, University of Miami, Coral Gables, Florida, USA
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10
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Goldfine CE, Knapp A, Goodman GR, Hasdianda MA, Huang H, Marshall AD, Keschner YG, Carreiro S, Jambaulikar G, Chai PR. Media and technology usage and attitudes in emergency department patients. Front Digit Health 2022; 4:894683. [DOI: 10.3389/fdgth.2022.894683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 09/27/2022] [Indexed: 11/05/2022] Open
Abstract
IntroductionDigital health technologies are increasingly being used in emergency medicine, many of which utilize smartphones and computers. Patient willingness to use these modalities is an important factor in successful implementation. Therefore, this study aimed to assess emergency department (ED) patients' use of and attitudes towards technology.MethodsThis was a pooled sub-analysis of ED patients (≥18 years old) that were enrolled in two studies evaluating the ED patient experience in response to novel technological interventions. Participants completed the Media and Technology Usage and Attitudes Scale (MTUAS) that assessed computer and smartphone ownership; frequency of use of phone calls, texting, email, and smartphones; and anxiety and dependence attitudes on these technologies.ResultsOne hundred and forty-four participants completed the survey. Mean age was 47.2 years (SD 17.94); 61.8% were female; and 61.1% were white. There was high usage of smartphones (93.1%) and computers (74.3%). Participants most frequently used phone calling and texting and least commonly used email. Participants had a positive attitude (mean 3.9/5, SD 0.68) towards the use of these technologies.DiscussionED patients reported high ownership of smartphones and computers, had a positive attitude towards their use, and had varying frequency with which they used different technologies. Future studies can use this information to inform the development of digital health interventions that utilize technologies that patients find most acceptable.
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11
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Goodman GR, Vaz C, Albrechta H, Boyer EW, Mayer KH, O'Cleirigh C, Chai PR. Ingestible Electronic Sensors for Monitoring Real-time Adherence to HIV Pre-exposure Prophylaxis and Antiretroviral Therapy. Curr HIV/AIDS Rep 2022; 19:433-445. [PMID: 36048309 PMCID: PMC9509467 DOI: 10.1007/s11904-022-00625-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW This review summarizes the recent advancements and future directions of digital pill systems (DPS) - which utilize ingestible sensors to directly measure medication ingestion events in real-time - in the context of HIV prevention and treatment. RECENT FINDINGS Two DPS are cleared by the US Food and Drug Administration. The bioequivalence and stability of digitized pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART) have been established, and pilot studies have demonstrated the feasibility and acceptability of using DPS for PrEP and ART adherence measurement. Important bioethical and implementation considerations have been identified for future clinical trials. Continued technological advancement may reduce barriers to use, and integration of DPS into behavioral interventions may facilitate adherence improvement efforts. DPS represent an innovative tool for PrEP and ART adherence measurement. Future work will optimize the technology to reduce operational barriers. DPS have significant potential for expansion across a diverse array of diseases, though key bioethical considerations must be examined prior to large-scale implementation.
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Affiliation(s)
- Georgia R Goodman
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Clint Vaz
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, USA
| | | | - Edward W Boyer
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical, Boston, MA, USA
| | - Conall O'Cleirigh
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Peter R Chai
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA.
- The Fenway Institute, Fenway Health, Boston, MA, USA.
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, USA.
- The Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA.
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12
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Litvinova O, Klager E, Tzvetkov NT, Kimberger O, Kletecka-Pulker M, Willschke H, Atanasov AG. Digital Pills with Ingestible Sensors: Patent Landscape Analysis. Pharmaceuticals (Basel) 2022; 15:ph15081025. [PMID: 36015173 PMCID: PMC9415622 DOI: 10.3390/ph15081025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/16/2022] Open
Abstract
The modern healthcare system is directly related to the development of digital health tools and solutions. Pills with digital sensors represent a highly innovative class of new pharmaceuticals. The aim of this work was to analyze the patent landscape and to systematize the main trends in patent protection of digital pills with ingestible sensors worldwide; accordingly, to identify the patenting leaders as well as the main prevailing areas of therapy for patent protection, and the future perspectives in the field. In July 2022, a search was conducted using Internet databases, such as the EPO, USPTO, FDA and the Lens database. The patent landscape analysis shows an increase in the number of patents related to digital pills with ingestible sensors for mobile clinical monitoring, smart drug delivery, and endoscopy diagnostics. The leaders in the number of patents issued are the United States, the European Patent Office, Canada, Australia, and China. The following main areas of patenting digital pills with ingestible sensors were identified: treatment in the field of mental health; HIV/AIDS; pain control; cardiovascular diseases; diabetes; gastroenterology (including hepatitis C); oncology; tuberculosis; and transplantology. The development of scientific and practical approaches towards the implementation of effective and safe digital pills will improve treatment outcomes, increase compliance, reduce hospital stays, provide mobile clinical monitoring, have a positive impact on treatment costs and will contribute to increased patient safety.
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Affiliation(s)
- Olena Litvinova
- Department of Management, Economy and Quality Assurance in Pharmacy, National University of Pharmacy, The Ministry of Health of Ukraine, 61002 Kharkiv, Ukraine
- Correspondence: (O.L.); (A.G.A.); Tel.: +380-67-300-78-49 (O.L.); +43-1401-6036-250 (A.G.A.)
| | - Elisabeth Klager
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, 1180 Vienna, Austria
| | - Nikolay T. Tzvetkov
- Institute of Molecular Biology “Roumen Tsanev”, Department of Biochemical Pharmacology and Drug Design, Bulgarian Academy of Sciences, 1113 Sofia, Bulgaria
| | - Oliver Kimberger
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, 1180 Vienna, Austria
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Maria Kletecka-Pulker
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, 1180 Vienna, Austria
- Institute for Ethics and Law in Medicine, University of Vienna, 1090 Vienna, Austria
| | - Harald Willschke
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, 1180 Vienna, Austria
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Atanas G. Atanasov
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, 1180 Vienna, Austria
- Institute of Genetics and Animal Biotechnology of the Polish Academy of Sciences, 05-552 Jastrzebiec, Poland
- Correspondence: (O.L.); (A.G.A.); Tel.: +380-67-300-78-49 (O.L.); +43-1401-6036-250 (A.G.A.)
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13
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Feasibility and Quality Validation of a Mobile Application for Enhancing Adherence to Opioids in Sickle Cell Disease. Healthcare (Basel) 2022; 10:healthcare10081506. [PMID: 36011162 PMCID: PMC9407817 DOI: 10.3390/healthcare10081506] [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: 06/23/2022] [Revised: 08/04/2022] [Accepted: 08/06/2022] [Indexed: 11/26/2022] Open
Abstract
Prescription opioid nonadherence, specifically opioid misuse, has contributed to the opioid epidemic and opioid-related mortality in the US. Popular methods to measure and control opioid adherence have limitations, but mobile health, specifically smartphone applications, offers a potentially useful technology for this purpose. We developed, tested, and validated the OpPill application using the Mobile Applications Rating Scale (MARS), a validated tool for assessing the quality of mobile health apps. The MARS contains four scales (range of each scale = 0–4) that rate Engagement, Functionality, Aesthetics, and Information Quality. It also assesses subjective quality, relevance, and overall application impact. Our application was built to be a mobile monitoring and reporting system intended to enhance opioid adherence by collecting data and providing systematic feedback on pain and opioid use. Patients (n = 28) all had one of various SCD genotypes, were ages 19 to 59 years (mean 36.56), 53.6% were female, and 39.3% had completed some college. Patients rated the OpPill application highly on all four scales: Engagement, 3.93 ± 0.73; Functionality, 4.54 ± 0.66; Aesthetics, 3.92 ± 0.81; Information, 3.91 ± 0.87. The majority of patients found the application to be relevant for their care. A total of 96% reported the information within the app was complete, while 4% estimated the information to be minimal or overwhelming. Patients (91.7%) overwhelmingly reported that the quality of information as it pertained to SCD patients was relevant; only 8.3% found the application to be poorly relevant to SCD. Similarly, patients (91.7%) overwhelmingly rated both the application’s performance and ease of use positively. The large majority of participants (85.7%) found the application to be interesting to use, while 74% found it entertaining. All users found the application’s navigation to be logical and accurate with consistent and intuitive gestural design. We conclude that the OpPill application, specifically targeted to monitor opioid use and pain and opioid behavior in patients with Chronic Non-Cancer Pain, was feasible and rated by SCD patients as easy-to-use using a validated rating tool.
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14
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Mason M, Cho Y, Rayo J, Gong Y, Harris M, Jiang Y. Technologies for Medication Adherence Monitoring and Technology Assessment Criteria: Narrative Review. JMIR Mhealth Uhealth 2022; 10:e35157. [PMID: 35266873 PMCID: PMC8949687 DOI: 10.2196/35157] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/23/2022] [Accepted: 01/28/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Accurate measurement and monitoring of patient medication adherence is a global challenge because of the absence of gold standard methods for adherence measurement. Recent attention has been directed toward the adoption of technologies for medication adherence monitoring, as they provide the opportunity for continuous tracking of individual medication adherence behavior. However, current medication adherence monitoring technologies vary according to their technical features and data capture methods, leading to differences in their respective advantages and limitations. Overall, appropriate criteria to guide the assessment of medication adherence monitoring technologies for optimal adoption and use are lacking. OBJECTIVE This study aims to provide a narrative review of current medication adherence monitoring technologies and propose a set of technology assessment criteria to support technology development and adoption. METHODS A literature search was conducted on PubMed, Scopus, CINAHL, and ProQuest Technology Collection (2010-present) using the combination of keywords medication adherence, measurement technology, and monitoring technology. The selection focused on studies related to medication adherence monitoring technology and its development and use. The technological features, data capture methods, and potential advantages and limitations of the identified technology applications were extracted. Methods for using data for adherence monitoring were also identified. Common recurring elements were synthesized as potential technology assessment criteria. RESULTS Of the 3865 articles retrieved, 98 (2.54%) were included in the final review, which reported a variety of technology applications for monitoring medication adherence, including electronic pill bottles or boxes, ingestible sensors, electronic medication management systems, blister pack technology, patient self-report technology, video-based technology, and motion sensor technology. Technical features varied by technology type, with common expectations for using these technologies to accurately monitor medication adherence and increase adoption in patients' daily lives owing to their unobtrusiveness and convenience of use. Most technologies were able to provide real-time monitoring of medication-taking behaviors but relied on proxy measures of medication adherence. Successful implementation of these technologies in clinical settings has rarely been reported. In all, 28 technology assessment criteria were identified and organized into the following five categories: development information, technology features, adherence to data collection and management, feasibility and implementation, and acceptability and usability. CONCLUSIONS This narrative review summarizes the technical features, data capture methods, and various advantages and limitations of medication adherence monitoring technology reported in the literature and the proposed criteria for assessing medication adherence monitoring technologies. This collection of assessment criteria can be a useful tool to guide the development and selection of relevant technologies, facilitating the optimal adoption and effective use of technology to improve medication adherence outcomes. Future studies are needed to further validate the medication adherence monitoring technology assessment criteria and construct an appropriate technology assessment framework.
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Affiliation(s)
- Madilyn Mason
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Youmin Cho
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Jessica Rayo
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Yang Gong
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Marcelline Harris
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Yun Jiang
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
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15
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Chai PR, Mohamed Y, Bustamante MJ, Goodman GR, Najarro J, Castillo-Mancilla J, Baez A, Bronzi O, Sullivan MC, Pereira LM, Baumgartner SL, Carnes TC, Mayer KH, Rosen RK, Boyer EW, O'Cleirigh C. DigiPrEP: A Pilot Trial to Evaluate the Feasibility, Acceptability, and Accuracy of a Digital Pill System to Measure PrEP Adherence in Men Who Have Sex With Men Who Use Substances. J Acquir Immune Defic Syndr 2022; 89:e5-e15. [PMID: 34753871 PMCID: PMC8740604 DOI: 10.1097/qai.0000000000002854] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/21/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adherence to once daily oral preexposure prophylaxis (PrEP) for HIV prevention can be challenging for men who have sex with men (MSM) with substance use. Digital pill systems (DPS) comprise a radiofrequency emitter integrated into a gelatin capsule containing PrEP, which transmits data to a wearable Reader following ingestion, thereby enabling direct, real-time adherence measurement. This study evaluated the feasibility, acceptability, and accuracy of a DPS to measure PrEP adherence. METHODS A 90-day, single-arm, open-label, pilot demonstration trial was conducted with adult, cisgender, HIV-negative MSM on PrEP with nonalcohol substance use. Feasibility was measured via DPS engagement and timeline followback. Acceptability was assessed via qualitative user experience interviews. Accuracy was evaluated via DPS performance metrics, pill counts, and DBS to quantify tenofovir diphosphate. RESULTS Sixteen MSM enrolled (median age, 32 years), and 15 completed the study. Engagement remained stable over time. Emergent nonadherence patterns included intercurrent substance use. The DPS was largely acceptable based on interviews; the predominant barrier to use was the Reader. DPS-recorded ingestions totaled 1099, including 83.9% were detected by Reader and 16.1% were reported manually. The DPS recorded 92.2% of 1192 total expected ingestions per pill counts. Point-biserial correlation (R = 0.58; 95% CI: 0.21 to 0.80; P = 0.047) and Pearson correlation (month 1: R = 0.85; 95% CI: 0.57 to 0.95; P = 0.0002; month 3: R = 0.75; 95% CI: 0.17 to 0.94; P = 0.0197) showed strong correlations between DPS-recorded adherence and tenofovir diphosphate in dried blood spots. CONCLUSION DPS are a feasible, acceptable, and accurate method of measuring PrEP adherence in MSM with substance use. Future investigations should incorporate DPS into behavioral interventions targeting nonadherence.
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Affiliation(s)
- Peter R. Chai
- Division of Medical Toxicology, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA
- The Fenway Institute, Fenway Health, Boston, MA
- The Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology, Cambridge, MA
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA
| | | | | | - Georgia R. Goodman
- The Fenway Institute, Fenway Health, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | | | - Jose Castillo-Mancilla
- Division of Infectious Diseases, School of Medicine, University of Colorado-AMC, Aurora, CO
| | | | | | - Matthew C. Sullivan
- The Fenway Institute, Fenway Health, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Luis M. Pereira
- Department of Anesthesiology, Boston Children's Hospital, Boston, MA
| | | | | | - Kenneth H. Mayer
- The Fenway Institute, Fenway Health, Boston, MA
- Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical, Boston, MA
| | - Rochelle K. Rosen
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI; and
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
| | - Edward W. Boyer
- Division of Medical Toxicology, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA
- The Fenway Institute, Fenway Health, Boston, MA
| | - Conall O'Cleirigh
- Division of Medical Toxicology, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
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16
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Chai PR, Vaz C, Goodman GR, Albrechta H, Huang H, Rosen RK, Boyer EW, Mayer KH, O'Cleirigh C. Ingestible electronic sensors to measure instantaneous medication adherence: A narrative review. Digit Health 2022; 8:20552076221083119. [PMID: 35251683 PMCID: PMC8891880 DOI: 10.1177/20552076221083119] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/30/2022] [Indexed: 12/03/2022] Open
Abstract
Objective Medication nonadherence contributes to significant morbidity and mortality worldwide. While many techniques to measure adherence exist, digital pill systems represent a novel, direct method of measuring adherence and a means of providing instantaneous adherence supports. In this narrative review, we discuss digital pill system research based on clinical trials and qualitative investigations conducted to date and potential future applications of digital pill system in medication adherence measurement. Methods We conducted a literature search in PubMed of English language peer-reviewed articles describing the use of digital pill system for medication adherence measurement between 2000 and 2021. We included all articles that described the deployment of ingestible sensors and those involving qualitative investigations of digital pill system with human subjects. Results A total of 95 articles were found on initial search; 75 were removed based on exclusion criteria. Included articles were categorized as investigations that deployed an ingestible sensor in human populations (n = 18), or those that conducted qualitative work (n = 3). For pilot studies, the mean accuracy of the sensor to successfully detect a medication ingestion event ranged from 68% to 100%. When digital pill systems were deployed in real-world clinical settings, accuracy ranged from 68% to 90% with lower accuracy due to nonadherence to digital pill system technology. Qualitative studies demonstrated that providers and patients perceive the digital pill system as a facilitator for improving adherence and as a potential platform for delivering adherence interventions. Additionally, ingestion data from digital pill system was viewed as useful in facilitating adherence discussions between clinicians and patients. Conclusions This narrative review demonstrates that the use of digital pill system is broadly feasible across multiple disease states including human immunodeficiency virus, hepatitis C infection, solid organ transplants, tuberculosis, schizophrenia, cardiovascular disease, and acute fractures, where adherence is closely linked to significant morbidity and mortality. It also highlights key areas of research that are still needed prior to broad-scale clinical deployment of such systems.
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Affiliation(s)
- Peter R Chai
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA.,The Fenway Institute, Fenway Health, Boston, MA, USA.,Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, USA.,The Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Clint Vaz
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, USA
| | - Georgia R Goodman
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA.,The Fenway Institute, Fenway Health, Boston, MA, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | | | - Henwei Huang
- The Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Rochelle K Rosen
- The Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA.,Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Edward W Boyer
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA.,The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA.,Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Conall O'Cleirigh
- The Fenway Institute, Fenway Health, Boston, MA, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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17
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Izzah Z, Zijp TR, Åberg C, Touw DJ, van Boven JFM. Electronic Smart Blister Packages to Monitor and Support Medication Adherence: A Usability Study. Patient Prefer Adherence 2022; 16:2543-2558. [PMID: 36124125 PMCID: PMC9482437 DOI: 10.2147/ppa.s374685] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 07/29/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE An electronic version of the Dosepak® (EDP) which records date and time of dosing events has been developed to monitor adherence to medication packaged in blisters. This study aimed to evaluate its usability and acceptance and to monitor dose-taking adherence for optimal implementation in future clinical trials and practice. METHODS Healthy volunteers aged over 18 years were asked to dispense placebo tablets twice daily from EDPs equipped with a re-usable electronic module for a total duration of four weeks. Afterwards, subjects were asked to complete an online questionnaire and partake in a short one-on-one interview. The usability of the EDP was assessed using the System Usability Scale (SUS), while dose-taking adherence was monitored by EDP records, pill counting, and self-report. The short interview explored user experiences in more detail. RESULTS Twenty subjects with median [IQR] age 41.5 [32-49.8] years, 55% female, 45% healthcare professionals, and 20% chronic medication users completed the study and found the EDP easy to use, with a mean [SD] SUS score of 78.0 [11.2]. Median [IQR] dose-taking adherence was 89% [82-95%] based on EDP records, 96.5% [89-100%] based on pill counting, 92% [91-96%] based on self-report, and the levels differed significantly (p < 0.05). Four themes emerged from the interviews: user preference, experience, patient burden, and ideas for improvement. Most participants preferred smaller sized blisters. They found the EDP simple to use and did not see any patient burden for its use in trials or clinical practice. Some reported forgetfulness and suggested reminders built into the blister or sent to their mobile phones. Adequate information or instruction should also be provided for older people and polypharmacy patients. CONCLUSION EDP had good perceived usability, was well accepted, and differed significantly from other adherence measurement methods. This study provides input to further guide scale-up of the blister packages.
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Affiliation(s)
- Zamrotul Izzah
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia
- Department of Pharmaceutical Analysis, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands
| | - Tanja R Zijp
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Christoffer Åberg
- Department of Pharmaceutical Analysis, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands
| | - Daan J Touw
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Pharmaceutical Analysis, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands
- Medication Adherence Expertise Center of the Northern Netherlands (MAECON), Groningen, the Netherlands
| | - Job F M van Boven
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Medication Adherence Expertise Center of the Northern Netherlands (MAECON), Groningen, the Netherlands
- Correspondence: Job FM van Boven, Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Hanzeplein 1 (Internal Postcode AP50), Groningen, 9713 GZ, the Netherlands, Tel +31 50 361 7893, Fax +31 50 361 4087, Email
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18
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Chai PR, Goodman G, Bustamante MJ, Mohamed Y, Castillo-Mancilla J, Boyer EW, Mayer KH, Rosen RK, Baumgartner SL, Buffkin E, O'Cleirigh C. Long-Term Stability of the Electronic Sensor Component of a Digital Pill System in Real-World Storage Settings. J Pharm Technol 2021; 37:135-139. [PMID: 34752557 DOI: 10.1177/8755122520985219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Digital pill systems comprise an ingestible sensor integrated into a gelatin capsule that overencapsulates medication allowing real-time measures of medication ingestion. These systems may improve the manner in which medication adherence can be assessed and supported. Objective: In this investigation, we tested the durability of the ingestible sensor as part of a clinical trial to measure the feasibility and acceptability of the system to measure adherence to once daily tenofovir disoproxil fumarate/emtricitabine (NCT03842436). Methods: Digital pills not dispensed during the study were stored in a pharmacy. Seventeen sensors were selected from digital pills stored for at least 12 months and activated in a simulated gastric environment. A radiofrequency spectrum analyzer and the reader device used in the clinical trial to capture ingestion events were used to measure activation of emitters. A passing evaluation was defined as an energized emitter within 30 minutes of immersion, ability to broadcast a signal for 10 minutes, and successful acquisition by the reader. Results: All ingestible sensors passed the stability test. Mean activation time in simulated gastric fluid was 3.33 minutes (SD = 1.47); emitters remained active for a mean of 47.72 minutes (SD = 1.78). These parameters matched guidelines defined in the ID-Cap system requirements for use in patients. Conclusions: Ingestible sensor components of the ID-Cap system were therefore stable after long-term storage.
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Affiliation(s)
- Peter R Chai
- Brigham and Women's Hospital, Boston, MA, USA.,The Fenway Institute, Boston, MA, USA.,Dana Farber Cancer Institute, Boston, MA, USA.,Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Georgia Goodman
- The Fenway Institute, Boston, MA, USA.,Massachusetts General Hospital, Boston, MA, USA
| | | | | | | | - Edward W Boyer
- Brigham and Women's Hospital, Boston, MA, USA.,The Fenway Institute, Boston, MA, USA
| | - Kenneth H Mayer
- The Fenway Institute, Boston, MA, USA.,Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | | | | | - Conall O'Cleirigh
- The Fenway Institute, Boston, MA, USA.,Massachusetts General Hospital, Boston, MA, USA
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19
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Dukes CK, Sheaffer EA. Biosensing Technology to Track Adherence: A Literature Review. Healthcare (Basel) 2021; 9:healthcare9101339. [PMID: 34683019 PMCID: PMC8544506 DOI: 10.3390/healthcare9101339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 09/20/2021] [Accepted: 10/04/2021] [Indexed: 11/16/2022] Open
Abstract
Tracking adherence can be a useful means of identifying opportunities to provide educational intervention to nonadherent patients. The aim of this study was to evaluate the ability of biosensing technology to track medication adherence. Searches of PubMed and Ovid IPA were conducted. The criteria for inclusion were studies that tracked and reported ingestion events. Studies that did not track ingestion events were excluded from this review. Titles and abstracts were assessed for relevance, and full-text reviews were performed on all potentially relevant studies. References from the studies retrieved from the literature searches were assessed for additional applicable articles. Overall, ingestion events were detected 91.3% of the time, with many of the failed detections being related to patients not using or inappropriately using the system. In the studies that looked at the latency time, the overall mean time to detection by the wearable sensor was between 1.1 and 5.1 min. With medication nonadherence being a persistent problem in healthcare, biosensing technology presents an innovative approach to tracking adherence. The technology has been shown to be accurate in its ability to track actual medication use in patients. It has also been shown to detect ingestions with a minimal delay after administration. Accessibility may be an issue with this technology in the future, and further studies may be necessary to access the viability of biosensing technology.
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Affiliation(s)
- Cody K. Dukes
- Alumnus, McWhorter School of Pharmacy, Samford University, Birmingham, AL 35229, USA;
| | - Elizabeth A. Sheaffer
- Department of Pharmaceutical, Social, and Administrative Sciences, McWhorter School of Pharmacy, Samford University, Birmingham, AL 35229, USA
- Correspondence: ; Tel.: +1-205-726-2896
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20
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Chai PR, Mohamed Y, Goodman G, Bustamante MJ, Sullivan MC, Najarro J, Mendez L, Mayer KH, Boyer EW, O'Cleirigh C, Rosen RK. Development of a digital pill and respondent behavioral intervention (PrEPSteps) for HIV pre-exposure prophylaxis adherence among stimulant using men who have sex with men. Transl Behav Med 2021; 12:6359129. [PMID: 34453536 DOI: 10.1093/tbm/ibab117] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The efficacy of pre-exposure prophylaxis (PrEP) for HIV prevention in men who have sex with men (MSM) is contingent upon consistent adherence. Digital pill systems (DPS) provide real-time, objective measurement of ingestions and can inform behavioral adherence interventions. Qualitative feedback was solicited from MSM who use stimulants to optimize a cognitive behavioral therapy (CBT)-based intervention (LifeSteps), used in conjunction with a DPS, to promote PrEP adherence (PrEPSteps). Seven focus groups and one individual qualitative interview were conducted in Boston, MA with cisgender, HIV-negative MSM who reported stimulant use and current PrEP use or interest. Focus groups and interviews explored reactions to the DPS and PrEPSteps messaging components: contingent reinforcement (CR), corrective feedback (CF), LifeSteps, and substance use Screening, Brief Intervention, and Referral to Treatment (SBIRT). Quantitative assessments were administered. Qualitative data were analyzed using applied thematic analysis. Twenty MSM participated. Most were White (N = 12), identified as homosexual or gay (N = 15), and college-educated (N = 15). Ages ranged from 24 to 68 years (median 35.5). Participants were willing to engage with the DPS and viewed it as beneficial for promoting adherence. Confirmatory CR messages were deemed acceptable, and a neutral tone was preferred. CF messages were viewed as most helpful and as promoting individual responsibility. LifeSteps was perceived as useful for contextualizing nonadherence. However, SBIRT was a barrier to DPS use; concerns around potential substance use stigma were reported. MSM who use stimulants were accepting of the DPS and PrEPSteps intervention. CR, CF, and LifeSteps messages were viewed as helpful, with modifications pertaining to tone and content; SBIRT messages were not preferred.
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Affiliation(s)
- Peter R Chai
- The Fenway Institute, Fenway Health, Boston, MA, USA.,Division of Medical Toxicology, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, USA.,The Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | - Georgia Goodman
- The Fenway Institute, Fenway Health, Boston, MA, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | | | - Matthew C Sullivan
- The Fenway Institute, Fenway Health, Boston, MA, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Jesse Najarro
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | | | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Edward W Boyer
- The Fenway Institute, Fenway Health, Boston, MA, USA.,Division of Medical Toxicology, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Conall O'Cleirigh
- The Fenway Institute, Fenway Health, Boston, MA, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Rochelle K Rosen
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA.,Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
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21
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Mallama CA, Greene C, Alexandridis AA, McAninch J, Dal Pan G, Meyer T. Patient-reported opioid analgesic use after discharge from surgical procedures: a systematic review. PAIN MEDICINE 2021; 23:29-44. [PMID: 34347101 DOI: 10.1093/pm/pnab244] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This systematic review synthesizes evidence on patient-reported outpatient opioid analgesic use post-surgery. METHODS We searched Pubmed (February 2019), Web of Science and Embase (June 2019) for U.S. studies describing patient-reported outpatient opioid analgesic use. Two reviewers extracted data on opioid analgesic use, standardized use, and performed independent quality appraisals based on the Cochrane Risk of Bias Tool and an adapted Newcastle-Ottawa scale. RESULTS Ninety-six studies met eligibility criteria; 56 had sufficient information to standardize use in oxycodone 5 mg tablets. Patient-reported opioid analgesic use varied widely by procedure type; knee and hip arthroplasty had the highest postoperative opioid use, and use after many procedures was reported as < 5 tablets. In studies that examined excess tablets, 25%-98% of the total tablets prescribed were reported to be excess, with most studies reporting that 50%-70% of tablets went unused. Factors commonly associated with higher opioid analgesic use included preoperative opioid analgesic use, higher inpatient opioid analgesic use, higher postoperative pain scores, and chronic medical conditions, among others. Estimates also varied across studies due to heterogeneity in study design, including length of follow-up and inclusion/exclusion criteria. CONCLUSION Self-reported post-surgery outpatient opioid analgesic use varies widely both across procedures and within a given procedure type. Contributors to within-procedure variation included patient characteristics, prior opioid use, intraoperative and perioperative factors, and differences in timing of opioid use data collection. We provide recommendations to help minimize variation caused by study design factors and maximize interpretability of forthcoming studies for use in clinical guidelines and decision-making.
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Affiliation(s)
- Celeste A Mallama
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, United States Food and Drug Administration, Silver Spring, MD, USA
| | - Christina Greene
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, United States Food and Drug Administration, Silver Spring, MD, USA
| | - Apostolos A Alexandridis
- Office of Science, Center for Tobacco Products, United States Food and Drug Administration, Silver Spring MD, USA. The work presented here was conducted while an ORISE fellow with the Center for Drug Evaluation and Research
| | - Jana McAninch
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, United States Food and Drug Administration, Silver Spring, MD, USA
| | - Gerald Dal Pan
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, United States Food and Drug Administration, Silver Spring, MD, USA
| | - Tamra Meyer
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, United States Food and Drug Administration, Silver Spring, MD, USA
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22
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Chai PR, Goodman G, Bustamante M, Mendez L, Mohamed Y, Mayer KH, Boyer EW, Rosen RK, O'Cleirigh C. Design and Delivery of Real-Time Adherence Data to Men Who Have Sex with Men Using Antiretroviral Pre-exposure Prophylaxis via an Ingestible Electronic Sensor. AIDS Behav 2021; 25:1661-1674. [PMID: 33219877 PMCID: PMC8084862 DOI: 10.1007/s10461-020-03082-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2020] [Indexed: 12/23/2022]
Abstract
Once daily tenofovir/emtricitabine when used for pre-exposure prophylaxis (PrEP) is effective in preventing HIV acquisition but requires consistent medication adherence. The use of ingestible technologies to monitor PrEP adherence can assist in understanding the impact of behavioral interventions. Digital pill systems (DPS) utilize an ingestible radiofrequency emitter integrated onto a gelatin capsule, which permits direct, real-time measurement of medication adherence. DPS monitoring may lead to discovery of nascent episodes of PrEP nonadherence and allow delivery of interventions that prevent the onset of sustained nonadherence. Yet, the acceptance and potential use of DPS in high-risk men who have sex with men (MSM; i.e., those who engage in condomless sex and use substances) is unknown. In this investigation, we conducted individual, semi-structured qualitative interviews with 30 MSM with self-reported non-alcohol substance use to understand their responses to the DPS, willingness and perceived barriers to its use, and their perceptions of its potential utility. We also sought to describe how MSM would potentially interact with a messaging system integrated into the DPS. We identified major themes around improved confidence of PrEP adherence patterns, safety of ingestible radiofrequency sensors, and design optimization of the DPS. They also expressed willingness to interact with messaging contingent on DPS recorded ingestion patterns. These data demonstrate that MSM who use substances find the DPS to be an acceptable method to measure and record PrEP adherence.
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Affiliation(s)
- Peter R Chai
- Division of Medical Toxicology, Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02411, USA.
- The Fenway Institute, Fenway Health, Boston, MA, USA.
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, USA.
- The Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology, Boston, MA, USA.
| | - Georgia Goodman
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | | | | | | | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
| | - Edward W Boyer
- Division of Medical Toxicology, Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02411, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Rochelle K Rosen
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Conall O'Cleirigh
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
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23
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Chai PR, Bustamante MJ, Goodman G, Mohamed Y, Najarro J, Sullivan MC, Castillo-Mancilla J, Coyle RP, Mayer KH, Rosen RK, Baumgartner SL, Alpert PE, Boyer EW, O'Cleirigh C. A Brief Training Program to Support the Use of a Digital Pill System for Medication Adherence: Pilot Descriptive Study. JMIR Form Res 2021; 5:e26213. [PMID: 33890863 PMCID: PMC8105755 DOI: 10.2196/26213] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/04/2021] [Accepted: 04/09/2021] [Indexed: 01/31/2023] Open
Abstract
Background Digital pill systems (DPSs), which comprise ingestible radiofrequency sensors integrated into a gelatin capsule that overencapsulates a medication, can directly measure ingestion events. Objective Teaching users to operate a DPS is vital to ensure the collection of actionable ingestion and adherence data. In this study, we aim to develop and pilot a training program, grounded in the Technology Acceptance Model, to instruct individuals on DPS operation. Methods A two-part training program, comprising in-person and text message–based components, was used with HIV-negative men who have sex with men with nonalcohol substance use, who had enrolled in a 90-day pilot demonstration study using the DPS to measure adherence to pre-exposure prophylaxis. We assessed the number of responses to text check-ins, the number and types of episodes where technical support was requested, the resolutions of such issues, and engagement with the program over the study period. Participant feedback on the program was evaluated through qualitative user experience interviews. Results A total of 15 participants were enrolled in and completed the program. Seven technical challenges related to DPS operations were reported across 5 participants. Most commonly, participants requested support connecting the wearable Reader device with their smartphone, charging the Reader, and operating the mobile app. A total of 6 issues were resolved asynchronously or in real time via phone; 1 required in-person evaluation and resolution. Preliminary qualitative findings indicate that both the in-person and remote follow-up components of the training program were perceived as acceptable. Suggested improvements included repeated DPS refresher sessions at in-person follow-up visits and enhanced written materials for the independent resolution of technological issues. Conclusions A brief two-part DPS training program, drawing from individuals’ experiences and from the Technology Acceptance Model, can provide valuable insights for users. The program also identifies and addresses several areas of actual or potential challenges related to operating a DPS and allows for the resolution of such issues within the first week of DPS use.
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Affiliation(s)
- Peter R Chai
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States.,The Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, United States.,The Fenway Institute, Boston, MA, United States.,Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, United States
| | | | - Georgia Goodman
- The Fenway Institute, Boston, MA, United States.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | | | | | - Matthew C Sullivan
- The Fenway Institute, Boston, MA, United States.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Jose Castillo-Mancilla
- Division of Infectious Disease, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Ryan P Coyle
- Division of Infectious Disease, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Kenneth H Mayer
- The Fenway Institute, Boston, MA, United States.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Rochelle K Rosen
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States.,Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | | | | | - Edward W Boyer
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States.,The Fenway Institute, Boston, MA, United States
| | - Conall O'Cleirigh
- The Fenway Institute, Boston, MA, United States.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
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24
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Bourke A, Dixon WG, Roddam A, Lin KJ, Hall GC, Curtis JR, van der Veer SN, Soriano-Gabarró M, Mills JK, Major JM, Verstraeten T, Francis MJ, Bartels DB. Incorporating patient generated health data into pharmacoepidemiological research. Pharmacoepidemiol Drug Saf 2020; 29:1540-1549. [PMID: 33146896 DOI: 10.1002/pds.5169] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 09/17/2020] [Accepted: 10/31/2020] [Indexed: 01/18/2023]
Abstract
Epidemiology and pharmacoepidemiology frequently employ Real-World Data (RWD) from healthcare teams to inform research. These data sources usually include signs, symptoms, tests, and treatments, but may lack important information such as the patient's diet or adherence or quality of life. By harnessing digital tools a new fount of evidence, Patient (or Citizen/Person) Generated Health Data (PGHD), is becoming more readily available. This review focusses on the advantages and considerations in using PGHD for pharmacoepidemiological research. New and corroborative types of data can be collected directly from patients using digital devices, both passively and actively. Practical issues such as patient engagement, data linking, validation, and analysis are among important considerations in the use of PGHD. In our ever increasingly patient-centric world, PGHD incorporated into more traditional Real-Word data sources offers innovative opportunities to expand our understanding of the complex factors involved in health and the safety and effectiveness of disease treatments. Pharmacoepidemiologists have a unique role in realizing the potential of PGHD by ensuring that robust methodology, governance, and analytical techniques underpin its use to generate meaningful research results.
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Affiliation(s)
| | - William G Dixon
- Arthritis Research UK Centre for Epidemiology, The University of Manchester, Manchester, UK
| | | | - Kueiyu Joshua Lin
- Brigham and Women's & Department of Medicine, Boston, Massachusetts, USA
| | | | - Jeffrey R Curtis
- Division of Clinical Immunology & Rheumatology, The University of Birmingham, Birmingham, Alabama, USA
| | - Sabine N van der Veer
- Centre for Health Informatics, Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | | | | | - Jacqueline M Major
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
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25
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Alipour A, Gabrielson S, Patel PB. Ingestible Sensors and Medication Adherence: Focus on Use in Serious Mental Illness. PHARMACY 2020; 8:pharmacy8020103. [PMID: 32560178 PMCID: PMC7355811 DOI: 10.3390/pharmacy8020103] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/09/2020] [Accepted: 06/11/2020] [Indexed: 12/16/2022] Open
Abstract
Background: Poor medication adherence is a major public health concern. Patients living with a serious mental illness (SMI) commonly present with non-adherence to their medication regimen, which can lead to relapse and hospitalizations. The high rates of antipsychotic non-adherence continue to persist despite several interventions and medication advances. This review evaluates the possible role of the ingestible sensor technology for medication adherence in different conditions, with a focus on use in the SMI schizophrenia. Methods: Literature searches were conducted in July 2019 in the PubMed database. Results: In small studies of ingestible sensor use, the average adherence ranged from 73.9% to 88.6% for SMI and ≥ 80% for cardiac and transplant (99.4%) patients. In SMI studies, patients were clinically stable, and the majority had a clinical global impression severity of “mild disease”. Patients generally experienced relatively minor dermatological adverse effects related to wearable sensor use. Conclusions: A medication with an ingestible sensor may help provide real-time objective medication-taking adherence information for clinicians. However, further studies are needed to understand the impact of use on adherence and improvement on treatment outcomes with the ingestible sensor technology.
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Affiliation(s)
- Azita Alipour
- College of Pharmacy, Marshall B. Ketchum University, Fullerton, CA 92831, USA;
| | - Stephen Gabrielson
- Health Sciences Library System, University of Pittsburgh, Pittsburgh, PA 15261, USA;
| | - Puja Baldev Patel
- College of Pharmacy, Marshall B. Ketchum University, Fullerton, CA 92831, USA;
- Correspondence:
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26
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Goldfine C, Lai JT, Lucey E, Newcomb M, Carreiro S. Wearable and Wireless mHealth Technologies for Substance Use Disorder. CURRENT ADDICTION REPORTS 2020; 7:291-300. [PMID: 33738178 DOI: 10.1007/s40429-020-00318-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Purpose of review The goal of this scoping review is to evaluate the advances in wearable and other wireless mobile health (mHealth) technologies in the treatment of substance use disorders. Recent findings There are a variety of wireless technologies under investigation for the treatment of substance use disorder. Wearable sensors are the most commonly used technology. They can be used to decrease heavy substance use, mitigate factors related to relapse, and monitor for overdose. New technologies pose distinct advantages over traditional therapies by increasing geographic availability and continuously providing feedback and monitoring while remaining relatively non-invasive. Summary Wearable and novel technologies are important to the evolving landscape of substance use treatment. As technologies continue to develop and show efficacy, they should be incorporated into multifactorial treatment plans.
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Affiliation(s)
- Charlotte Goldfine
- University of Massachusetts Medical School, Department of Emergency Medicine, Division of Medical Toxicology, Worcester, MA
| | - Jeffrey T Lai
- University of Massachusetts Medical School, Department of Emergency Medicine, Division of Medical Toxicology, Worcester, MA
| | - Evan Lucey
- University of Massachusetts Medical School, Department of Emergency Medicine, Division of Medical Toxicology, Worcester, MA
| | - Mark Newcomb
- University of Massachusetts Medical School, Department of Emergency Medicine, Division of Medical Toxicology, Worcester, MA
| | - Stephanie Carreiro
- University of Massachusetts Medical School, Department of Emergency Medicine, Division of Medical Toxicology, Worcester, MA
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27
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Kim J, Kassels AC, Costin NI, Schmidt H. Remote monitoring of medication adherence and patient and industry responsibilities in a learning health system. JOURNAL OF MEDICAL ETHICS 2020; 46:386-391. [PMID: 32366704 DOI: 10.1136/medethics-2019-105667] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 02/10/2020] [Accepted: 02/24/2020] [Indexed: 06/11/2023]
Abstract
A learning health system (LHS) seeks to establish a closer connection between clinical care and research and establishes new responsibilities for healthcare providers as well as patients. A new set of technological approaches in medication adherence monitoring can potentially yield valuable data within an LHS, and raises the question of the scope and limitations of patients' responsibilities to use them. We argue here that, in principle, it is plausible to suggest that patients have a prima facie obligation to use novel adherence monitors. However, the strength of the obligations depends considerably on the extent to which data that adherence monitors generate are, in fact, used to further the goals of LHSs. The way in which data ownership is structured in the USA poses a considerable challenge here, while the European Union framework offers a more promising alternative.
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Affiliation(s)
- Junhewk Kim
- Dental Education Research Center, College of Dentistry, Yonsei University, Seoul, Seodaemun-gu, Republic of Korea
| | - Austin Connor Kassels
- Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- School of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Nathaniel Isaac Costin
- Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Hackensack Meridian School of Medicine, Seton Hall University, Nutley, New Jersey, USA
| | - Harald Schmidt
- Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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28
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Haga SB. Toward digital-based interventions for medication adherence and safety. Expert Opin Drug Saf 2020; 19:735-746. [DOI: 10.1080/14740338.2020.1764935] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Susanne B Haga
- Duke School of Medicine, Center for Applied Genomics and Precision Medicine, Durham, NC, USA
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29
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A Review of Inpatient Opioid Consumption and Discharge Prescription Patterns After Orthopaedic Procedures. J Am Acad Orthop Surg 2020; 28:279-286. [PMID: 31633659 DOI: 10.5435/jaaos-d-19-00279] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Tailoring opioid prescriptions to inpatient use after orthopaedic procedures may effectively control pain while limiting overprescription but may not be common in the current orthopaedic practice. METHODS A retrospective review identified opioid-naïve patients admitted after any orthopaedic procedure. Daily and total prescription quantities as well as patient-specific factors were collected. The total opioids used the day before discharge was compared with the total opioids prescribed for the day after discharge. Refill rates were then compared between patients whose daily discharge prescription regimen far exceeded or approximated their predischarge opioid consumption. RESULTS Six hundred thirteen patients were included (ages 18 to 95 years). The total opioids prescribed for the 24 hours after discharge significantly exceeded the opioids consumed the 24 hours before discharge for each orthopaedic subspecialty. The excessive-prescription group (409 patients) received greater daily opioid (120 oral morphine equivalents [OMEs] versus 60 OMEs; P < 0.01) and total opioid (750 OMEs versus 512.5 OMEs; P < 0.01) at discharge but was more likely to refill their opioid prescription within 30 days of discharge (27.6% versus 20.1%; P = 0.043). DISCUSSION Opioid regimens prescribed after an orthopaedic surgery frequently exceed inpatient opioid use. Opioid regimens that approximate inpatient use may help curb overprescription and are not associated with higher refill rates compared with more excessive prescriptions. LEVEL OF EVIDENCE Level III, Retrospective Cohort Study.
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30
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Martani A, Geneviève LD, Poppe C, Casonato C, Wangmo T. Digital pills: a scoping review of the empirical literature and analysis of the ethical aspects. BMC Med Ethics 2020; 21:3. [PMID: 31914995 PMCID: PMC6950823 DOI: 10.1186/s12910-019-0443-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 12/27/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Digital Pills (DP) are an innovative drug-device technology that permits to combine traditional medications with a monitoring system that automatically records data about medication adherence as well as patients' physiological data. Although DP are a promising innovation in the field of digital medicine, their use has also raised a number of ethical concerns. These ethical concerns, however, have been expressed principally from a theoretical perspective, whereas an ethical analysis with a more empirically oriented approach is lacking. There is also a lack of clarity about the empirical evidence available concerning the application of this innovative digital medicine. METHODS To map the studies where DP have been tested on patients and discuss the ethically relevant issues evident therein, we performed a scoping review of the empirical literature concerning DP. RESULTS Our search allowed us to identify 18 papers reporting on studies where DP were tested on patients. These included studies with different designs and involving patients with a variety of conditions. In the empirical literature, a number of issues with ethical relevance were evident. At the patient level, the ethical issues include users' interaction with DP, personal sphere, health-related risks and patients' benefits. At the provider level, ethically relevant issues touch upon the doctor-patient relationship and the question of data access. At the societal level, they concern the benefits to society, the quality of evidence and the dichotomy device-medicine. CONCLUSIONS We conclude that evidence concerning DP is not robust and that more research should be performed and study results made available to evaluate this digital medicine. Moreover, our analysis of the ethically relevant aspects within empirical literature underscores that there are concrete and specific open questions that should be tackled in the ethical discussion about this new technological solution.
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Affiliation(s)
- Andrea Martani
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, Basel, Switzerland
| | - Lester Darryl Geneviève
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, Basel, Switzerland
| | - Christopher Poppe
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, Basel, Switzerland
| | | | - Tenzin Wangmo
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, Basel, Switzerland
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31
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Bell KM, Haberer JE. Actionable Adherence Monitoring: Technological Methods to Monitor and Support Adherence to Antiretroviral Therapy. Curr HIV/AIDS Rep 2019; 15:388-396. [PMID: 30232578 DOI: 10.1007/s11904-018-0413-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW Current digital technologies are being used for "actionable adherence monitoring"; that is, technologies that can be used to identify episodes of non-adherence to ART in a timely manner such that tailored interventions based on adherence data can be provided when and where they are needed most. RECENT FINDINGS Current digital communication technologies used to monitor ART adherence include electronic adherence monitors (EAMs), digital ingestion monitors, cellular phones, and electronic pharmacy refill tracking systems. Currently available real-time adherence monitoring approaches based on cellular technology allow for the delivery of interventions precisely when and where they are needed. Such technology can potentially enable significant efficiency of care delivery and impact on adherence and associated clinical outcomes. Standard digital advances, such as automated reminders in EAM and electronic pharmacy records, may also achieve improvements with relatively lower cost and easier implementation. Future research is needed to improve the functionality of these approaches, with attention paid to system-level issues through implementation science, as well as acceptability and ethical considerations at the individual level.
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Affiliation(s)
- Kate M Bell
- Center for Global Health, Massachusetts General Hospital, 125 Nashua St, Suite 722, Boston, MA, 02114, USA
| | - Jessica E Haberer
- Center for Global Health, Massachusetts General Hospital, 125 Nashua St, Suite 722, Boston, MA, 02114, USA.
- Harvard Medical School, Boston, MA, USA.
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32
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Veronesi F, Tschon M, Visani A, Fini M. Biosensors for real-time monitoring of physiological processes in the musculoskeletal system: A systematic review. J Cell Physiol 2019; 234:21504-21518. [PMID: 31062360 DOI: 10.1002/jcp.28753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/26/2019] [Accepted: 04/11/2019] [Indexed: 11/09/2022]
Abstract
Biosensors are composed of (bio)receptors, transducers, and detection systems and are able to convert the biological stimulus into a measurable signal. This systematic review evaluates the current state of the art of innovation and research in this field, identifying the biosensors that in vitro monitor the musculoskeletal system cellular processes. Two databases found 20 in vitro studies, from January 1, 2008 to December 31, 2017, dealing with musculoskeletal system cells. The biosensors were divided into two groups based on the transduction mechanism: optical or electrochemical. The first group evaluated osteoblasts or mesenchymal stem cell (MSC) biocompatibility, viability, differentiation, alkaline phosphatase, enzyme, and protein detection. The second group detected cell impedance, ATP release, and superoxide concentration in tenocytes, osteoblasts, MSCs, and myoblasts. This review highlighted that the in vitro scenario is still at an early phase and limited for what concerns both the type of bioanalyte and for the type of system detector used.
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Affiliation(s)
- Francesca Veronesi
- Laboratory of Preclinical and Surgical Studies, IRCCS-Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Matilde Tschon
- Laboratory of Preclinical and Surgical Studies, IRCCS-Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Andrea Visani
- Laboratory of Biomechanics and Technology Innovation, IRCCS-Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Milena Fini
- Laboratory of Preclinical and Surgical Studies, IRCCS-Istituto Ortopedico Rizzoli, Bologna, Italy
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33
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Grace TR, Khanna K, Choo KJ, Croci R, Feeley BT, Ma CB, Zhang AL. The influence of preoperative opioid use on inpatient opioid requirements and discharge prescriptions after primary shoulder arthroplasty. J Shoulder Elbow Surg 2018; 27:1572-1579. [PMID: 29703681 DOI: 10.1016/j.jse.2018.02.067] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 02/24/2018] [Accepted: 02/28/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Active opioid users experience more pain and require more opioids after primary shoulder arthroplasty than non-opioid users. However, it is unknown whether discharge prescription regimens are tailored to these different postoperative opioid requirements. METHODS We performed a retrospective analysis of a prospectively collected cohort of patients who underwent primary shoulder replacement over a 15-month period. Demographic and operative variables were collected and compared between prior opioid users and non-opioid users. Inpatient opioid requirements, daily discharge prescription regimens, total prescription quantities, and rates of persistent opioid use 6 weeks after surgery were also compared between these cohorts. RESULTS A total of 119 patients were analyzed (mean age, 68 years; 53% men; 39.5% prior opioid users). Prior opioid users required considerably more opioids on the first (60 oral morphine equivalents [OMEs] vs 45 OMEs, P = .01) and last (42 OMEs vs 15 OMEs, P < .001) hospitalization days but were discharged with similar daily opioid regimens (90 OMEs vs 90 OMEs, P = .3), total opioid quantities (600 OMEs vs 600 OMEs, P = .24), and total pills (80 vs 60, P = .27) compared with non-opioid users. Persistent opioid use 6 weeks after surgery was 7-fold higher for prior opioid users than nonusers (71.0% vs 9.1%, P < .001). CONCLUSIONS Daily and total opioid regimens prescribed after primary shoulder arthroplasty were similar between prior opioid users and nonusers despite large differences in their inpatient opioid requirements. Tailoring discharge opioid prescription regimens to inpatient use appears feasible and warrants further study.
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Affiliation(s)
- Trevor R Grace
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA.
| | - Krishn Khanna
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Kevin J Choo
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Rhiannon Croci
- Department of Health Informatics, University of California, San Francisco, San Francisco, CA, USA
| | - Brian T Feeley
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - C Benjamin Ma
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Alan L Zhang
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
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Combining ecological momentary assessment with objective, ambulatory measures of behavior and physiology in substance-use research. Addict Behav 2018; 83:5-17. [PMID: 29174666 DOI: 10.1016/j.addbeh.2017.11.027] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 11/02/2017] [Accepted: 11/02/2017] [Indexed: 02/06/2023]
Abstract
Whereas substance-use researchers have long combined self-report with objective measures of behavior and physiology inside the laboratory, developments in mobile/wearable electronic technology are increasingly allowing for the collection of both subjective and objective information in participants' daily lives. For self-report, ecological momentary assessment (EMA), as implemented on contemporary smartphones or personal digital assistants, can provide researchers with near-real-time information on participants' behavior and mood in their natural environments. Data from portable/wearable electronic sensors measuring participants' internal and external environments can be combined with EMA (e.g., by timestamps recorded on questionnaires) to provide objective information useful in determining the momentary context of behavior and mood and/or validating participants' self-reports. Here, we review three objective ambulatory monitoring techniques that have been combined with EMA, with a focus on detecting drug use and/or measuring the behavioral or physiological correlates of mental events (i.e., emotions, cognitions): (1) collection and processing of biological samples in the field to measure drug use or participants' physiological activity (e.g., hypothalamic-pituitary-adrenal axis activity); (2) global positioning system (GPS) location information to link environmental characteristics (disorder/disadvantage, retail drug outlets) to drug use and affect; (3) ambulatory electronic physiological monitoring (e.g., electrocardiography) to detect drug use and mental events, as advances in machine learning algorithms make it possible to distinguish target changes from confounds (e.g., physical activity). Finally, we consider several other mobile/wearable technologies that hold promise to be combined with EMA, as well as potential challenges faced by researchers working with multiple mobile/wearable technologies simultaneously in the field.
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A Review of Medication Adherence Monitoring Technologies. APPLIED SYSTEM INNOVATION 2018. [DOI: 10.3390/asi1020014] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Snyder CW, Dorsey ER, Atreja A. The Best Digital Biomarkers Papers of 2017. Digit Biomark 2018; 2:64-73. [PMID: 32095757 PMCID: PMC7015358 DOI: 10.1159/000489224] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 04/13/2018] [Indexed: 12/24/2022] Open
Abstract
The use and evaluation of digital biomarkers, objective and quantifiable measures of biology, and health collected through digital devices is growing rapidly. To highlight some of the most promising work in the field, we have compiled a list of the top digital biomarkers papers from the past year. Eligible papers reported on original research that evaluated a digital sensor (e.g., smartphone, wearable sensor, implantable device) in humans and was published in a peer-reviewed journal in 2017. Nominations were solicited from the editorial board of Digital Biomarkers and supplemented by papers the editorial team identified from Web of Science, Google Scholar, and PubMed. The editorial board then selected up to ten papers to be recognized among 28 nominations. Here, we present all of the nominated papers and profile the eight that received the most votes. The top eight papers evaluated 1,290 individuals with digital pills, smartwatches, wearable devices, and electronic inhalers in disease states ranging from dementia to diabetes and from Parkinson disease to pain.
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Affiliation(s)
- Christopher W. Snyder
- Center for Health + Technology, University of Rochester Medical Center, Rochester, New York, USA
| | - E. Ray Dorsey
- Center for Health + Technology, University of Rochester Medical Center, Rochester, New York, USA
| | - Ashish Atreja
- AppLab, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Chai PR, Carreiro S, Innes BJ, Chapman B, Schreiber KL, Edwards RR, Carrico AW, Boyer EW. Oxycodone Ingestion Patterns in Acute Fracture Pain With Digital Pills. Anesth Analg 2017; 125:2105-2112. [PMID: 29189367 PMCID: PMC5726569 DOI: 10.1213/ane.0000000000002574] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Opioid analgesics are commonly prescribed on an as-needed (PRN) basis for acute painful conditions. Uncertainty of how patients actually take PRN opioids, coupled with a desire to completely cover pain, leads to variable and overly generous opioid prescribing practices, resulting in a surplus of opioids. This opioid surplus becomes a source for diversion and nonmedical opioid use. Understanding patterns of actual opioid ingestion after acute painful conditions can help clinicians counsel patients on safe opioid use, and allow timely recognition and intervention when escalating opioid self-dosing occurs, to prevent tolerance and addiction. METHODS We used a novel oxycodone digital pill system (ingestible biosensor within a standard gelatin capsule combined with 5-mg oxycodone) that when ingested, is activated by the chloride ion gradient in the stomach thereby emitting a radiofrequency signal captured by a wearable reader. The reader relays ingestion data to a cloud-based server that displays ingestion events to the study team. We deployed the oxycodone digital pill among opioid-naive individuals discharged from the emergency department with acute fracture pain. Participants were trained on digital pill operation and discharged with twenty-one 5-mg oxycodone digital pills. They were instructed to take digital pills PRN for pain on discharge. We conducted a brief interview 7 days after study enrollment, at which point participants returned the digital pill system. We identified oxycodone ingestion events in real time by data from the digital pill system and performed pill counts at the return visit to validate digital pill reporting of medication ingestion. RESULTS In this study, 26 individuals were approached; 16 enrolled with 15 completing the study. Participants ingested a median of 6 (3-9.5) oxycodone digital pills over the course of 7 days, with 82% of the oxycodone dose ingested in the first 3 days. In individuals who required operative repair, 86% (N = 6) continued to ingest opioids at 1 week. There was substantial variability in ingestion patterns between individuals. CONCLUSIONS The utilization patterns of individuals with acute fracture pain could be captured using a digital pill system and revealed a median opioid ingestion of 45-mg morphine equivalents for acute pain over 7 days. Seven participants ceased using opioids within 4 days after discharge from the emergency department, although operative repair was associated with longer use. This digital pill system was able to measure changes in and patterns of opioid self-dosing, which varied between patients.
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Affiliation(s)
- Peter R Chai
- Division of Medical Toxicology, Department of Emergency Medicine, Brigham and Women’s Hospital, 75 Francis Street, Neville House, Boston, MA 02115, United States of America
| | - Stephanie Carreiro
- Division of Medical Toxicology, Department of Emergency Medicine, University of Massachusetts Medical School, 55 Lake Ave N, Worcester, MA 01655, United States of America
| | - Brendan J Innes
- Division of Medical Toxicology, Department of Emergency Medicine, University of Massachusetts Medical School, 55 Lake Ave N, Worcester, MA 01655, United States of America
| | - Brittany Chapman
- Division of Medical Toxicology, Department of Emergency Medicine, University of Massachusetts Medical School, 55 Lake Ave N, Worcester, MA 01655, United States of America
| | - Kristin L Schreiber
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, United States of America
| | | | - Adam W Carrico
- Department of Public Health Sciences, University of Miami, 1120 NW 14St, Suite 912, Miami, FL 33136
| | - Edward W Boyer
- Division of Medical Toxicology, Department of Emergency Medicine, Brigham and Women’s Hospital, 75 Francis Street, Neville House, Boston, MA 02115, United States of America
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Abstract
Epidemic increases in opioid use in the USA and globally highlight the need for effective adjunctive therapies to opioid-based analgesia. Given the shortcomings of behavioral adjuncts to opioid-based pain treatment, an urgent need exists for pain-related behavioral interventions that resonate with broad patient populations, can be delivered confidentially in any environment, and can incorporate new content automatically. Understanding the potential for automated behavioral therapies like music therapy in modulating the experience of pain may unlock methods to transition patients to lower doses of pharmacologic therapy or provide alternatives to opioids during acute exacerbations of pain. This manuscript describes the neurologic mechanism of action, theoretical basis, and potential applications of personalized music as a smartphone-based mHealth intervention for acute and chronic pain management.
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Integrating Personalized Technology in Toxicology: Sensors, Smart Glass, and Social Media Applications in Toxicology Research. J Med Toxicol 2017; 13:166-172. [PMID: 28405896 DOI: 10.1007/s13181-017-0611-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 03/07/2017] [Accepted: 03/15/2017] [Indexed: 02/04/2023] Open
Abstract
Rapid proliferation of mobile technologies in social and healthcare spaces create an opportunity for advancement in research and clinical practice. The application of mobile, personalized technology in healthcare, referred to as mHealth, has not yet become routine in toxicology. However, key features of our practice environment, such as frequent need for remote evaluation, unreliable historical data from patients, and sensitive subject matter, make mHealth tools appealing solutions in comparison to traditional methods that collect retrospective or indirect data. This manuscript describes the features, uses, and costs associated with several of common sectors of mHealth research including wearable biosensors, ingestible biosensors, head-mounted devices, and social media applications. The benefits and novel challenges associated with the study and use of these applications are then discussed. Finally, opportunities for further research and integration are explored with a particular focus on toxicology-based applications.
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