A Scoping Review of the Quality and the Design of Evaluations of Mobile Health, Telehealth, Smart Pump and Monitoring Technologies Performed in a Pharmacy-Related Setting

Tele-pharmacy Anticoagulation Clinic During COVID-19 Pandemic: Patient Outcomes

Introduction: It is well-established that clinical pharmacist-managed anticoagulation services achieve superior anticoagulation control, with a positive impact. At King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia, the structure of anticoagulation management is a pharmacist-managed specialty service. With the current COVID-19 situation, measures were taken to assure the continuity of patient care by establishing tele-pharmacy anticoagulation clinics. Materials and Methods: This was a prospective study with patients prescribed anticoagulation and followed up for 3 months. Since establishing the anticoagulation virtual clinic in March 2020, 270 patients were recruited in the study. The data collected included age, gender, comorbidities, indication for anticoagulation, intended duration of treatment, warfarin dose, testing of International Normalized Ratio (INR), INR target, range of INR values, time INR that was within the therapeutic range (TTR), and complications of therapy (bleeding and/or bruises). The patients were asked to complete the pharmacist satisfaction survey (PSS) after their consultation to assess patient satisfaction with the new virtual consultation system. Linguistic and cultural validation was conducted for the questionnaire. Results: A total of 270 patients were included in the study. The mean percentage of overall INR values in the range was 59.39% ± 32.84, and the mean time with the overall INR was within the therapeutic range 57.81% ± 32.08. Thirty-one percent of the sample had good anticoagulation control (time in therapeutic range >70%). The median satisfaction score was 32 (IQR 28-36) with a maximum score of 40. Conclusion: This is the first study to assess the tele-pharmacy anticoagulation clinic's efficiency and patient satisfaction in Saudi Arabia during the COVID-19 pandemic. This type of consultation was as effective as face-to-face consultations. The study also highlighted that though the reduction in the cost of care was not substantial, there was a significant increase in resource (clinical pharmacist) utilization as a result of this model. The adoption of tele-pharmacy resulted in time savings for the clinical pharmacists who can be utilized in many other improvement projects in adult ambulatory clinics to ensure the delivery of better quality and safe patient care.

A review of features and characteristics of smart medication adherence products

Background

Smart medication adherence products (smart MAPs) capture and transmit real-time medication intake by using various means of connectivity, allowing for remote monitoring. Numerous such products with different features are available to address medication nonadherence. A comparison of the features of these products is needed for clinical decision-making. Therefore, the objective of this review was to compare smart MAPs available for in-home use.

Methods

We searched grey and published literature and videos to identify smart MAPs. To be considered smart, products required 2 features: connectivity (the ability for collected data to exist outside the physical device) and automaticity (the ability for data to be analyzed or processed automatically). Products were excluded if product descriptions were not available in English, not for in-home use and unable to dispense medications.

Results

Of the 51 products identified, 38 commercially available and 13 prototypes met the definition. Of these, 75% (n = 38) contained alarms, 24% (n = 12) were unit-dose, 63% (n = 32) were multidose, 43% (n = 22) had locking features, 41% (n = 21) were portable and 88% (n = 45) sent notifications to patients. The cost of marketed products, excluding subscriptions, ranged from $10 to $1500 USD. Some products required a monthly (n = 16) or yearly (n = 1) subscription ranging from $10 to $100 USD.

Discussion

There is a growing market of smart MAPs for in-home patient use with variable features. Clinicians can use these features to identify and recommend products according to the specific needs of their patients to address medication adherence. Can Pharm J (Ott) 2021;154:xx-xx.

Hospital Investment Decisions in Healthcare 4.0 Technologies: Scoping Review and Framework for Exploring Challenges, Trends, and Research Directions

BACKGROUND

Alternative approaches to analyzing and evaluating health care investments in state-of-the-art technologies are being increasingly discussed in the literature, especially with the advent of Healthcare 4.0 (H4.0) technologies or eHealth. Such investments generally involve computer hardware and software that deal with the storage, retrieval, sharing, and use of health care information, data, and knowledge for communication and decision-making. Besides, the use of these technologies significantly increases when addressed in bundles. However, a structured and holistic approach to analyzing investments in H4.0 technologies is not available in the literature.

OBJECTIVE

This study aims to analyze previous research related to the evaluation of H4.0 technologies in hospitals and characterize the most common investment approaches used. We propose a framework that organizes the research associated with hospitals' H4.0 technology investment decisions and suggest five main research directions on the topic.

METHODS

To achieve our goal, we followed the standard procedure for scoping reviews. We performed a search in the Crossref, PubMed, Scopus, and Web of Science databases with the keywords investment, health, industry 4.0, investment, health technology assessment, healthcare 4.0, and smart in the title, abstract, and keywords of research papers. We retrieved 5701 publications from all the databases. After removing papers published before 2011 as well as duplicates and performing further screening, we were left with 244 articles, from which 33 were selected after in-depth analysis to compose the final publication portfolio.

RESULTS

Our findings show the multidisciplinary nature of the research related to evaluating hospital investments in H4.0 technologies. We found that the most common investment approaches focused on cost analysis, single technology, and single decision-maker involvement, which dominate bundle analysis, H4.0 technology value considerations, and multiple decision-maker involvement.

CONCLUSIONS

Some of our findings were unexpected, given the interrelated nature of H4.0 technologies and their multidimensional impact. Owing to the absence of a more holistic approach to H4.0 technology investment decisions, we identified five promising research directions for the topic: development of economic valuation methodologies tailored for H4.0 technologies; accounting for technology interrelations in the form of bundles; accounting for uncertainties in the process of evaluating such technologies; integration of administrative, medical, and patient perspectives into the evaluation process; and balancing and handling complexity in the decision-making process.

Qualitative and Quantitative Analysis of Definitions of e-Health and m-Health

Objectives

Skills to employ nursing informatics to promote the health of individuals is of such importance that it is considered a core competence. Although investments are made to increase the use of e-health, there is no full understanding of the usability of e-health for healthcare. This paper presents a current picture of how e-health and m-health are defined and used as well as the effects their usage may have on the intended target group.

Methods

Peer-reviewed open-access papers and grey literature that define e-health and m-health from PubMed, SpringerLink, and Google.com were randomized. A mixed method design with an inductive approach was employed. Open-source software were used for analysis.

Results

The overview includes 30 definitions of e-health and m-health, respectively. The definitions were thematised into 14 narrative themes. The results of the study, and primarily a three-level model, provide an understanding of how different types of e-health and m-health can be put into practice, and the effects or consequences of using them, which may be either positive or negative.

Conclusions

Mobility and flexibility is important for both m-health and e-health. Five keywords that characterize the definitions of e-health and m-health are "health", "mobile", "use", "information", and "technology". E-health or m-health cannot replace human actors because e-health and m-health consist of social and material interactions. Using e-health and m-health is, thus, about developing healthcare without compromising native relics.

The role of self-efficacy, flexibility, and gender in pharmacy students' health information technology readiness

INTRODUCTION

Pharmacy students' characteristics and attitudes towards health information technology (HIT) may influence their willingness to learn, adopt, and utilize technology in healthcare settings. Future pharmacists will play a key role in the successful implementation of HIT, yet their technology readiness is not well understood. The goal of this study was to understand pharmacy students' attitudes regarding HIT and identify personal characteristics and psychosocial factors that predict their readiness to use HIT in future clinical practice.

METHODS

Using an anonymous online survey, data were collected from 148 pharmacy students. Linear regression modeling was used to determine if gender, flexible thinking, and openness to using technology, and technology self-efficacy were associated with students' readiness to utilize HIT tools in future clinical practice.

RESULTS

Regression modeling successfully explained 15% of the variance in predicting students' readiness to utilize HIT tools: F(3, 144) = 8.31, p < 0.001 with an R2 of 0.148 (adj R² = 0.13). Greater information technology self-efficacy, more openness to change (in academic/work settings), and being male were associated with readiness to utilize HIT.

CONCLUSIONS

With the increased adoption of HIT in pharmacy practice, innovative approaches to HIT education are needed. Curricula that help students overcome obstacles to embracing technology may now be warranted. With enhanced training and engagement involving more than just didactic lessons, pharmacy students may not only feel confident in their ability to embrace HIT in future practice but feel professional satisfaction, increasing the likelihood for improved patient care and health system sustainability.

Conceptual Framework of the Impact of Health Technology on Healthcare System

The World Health Organization (WHO) promotes health systems strengthening as a means of improving population health, especially in low- and middle-income countries. The United Nations Sustainable Development Goals highlight the importance of investing in workforce development to improve population health and economic well-being. In relation to pharmaceuticals, health systems face challenges in terms of i) guaranteeing access to needed drugs, ii) rationalizing medicines use, and iii) avoiding harm from adverse events. There is a pressing need to better understand the relationships between technology and pharmacy practice when strengthening pharmaceutical care systems. In response, this paper examines ways in which harnessing new technologies can change pharmacy practice and strengthen pharmaceutical systems for the benefit of patients. The paper will present a conceptual framework as well as exploring case studies.

The Impact of Technology on Safe Medicines Use and Pharmacy Practice in the US

For decades it has been suggested that pharmacists are under-utilized and could better use their knowledge and experience to improve the use of medicines. The traditional roles for pharmacists have been preparing and distributing medicines, but this has limited both the location where they work and the available time to work more closely with other healthcare professionals to improve both the effectiveness and safety of medicines. Newly emerging technologies have made this possible. Examples include robotics that automate preparation and distribution of medicines, electronic health information, clinical decision support systems, and machine readable coding on medicine packaged. As a result of the use of these technologies, pharmacists in hospitals are working outside the hospital pharmacy and spending more time in medication therapy management activities compared to traditional distribution roles.

The Connected Community Pharmacy: Benefits for Healthcare and Implications for Health Policy

The need for interoperability of healthcare Information Technology (IT) systems in order to provide safe, efficient, and coordinated healthcare is universally recognized. Various health economies, such as the United Kingdom, the United States, and Australia, are seeking to develop regional, state-wide, or national systems of healthcare interoperability. In England, the community pharmacy network is a significant health provider, with important implications for provision of healthcare in deprived areas because of its accessibility. Historically, however, community pharmacies have operated on a silo basis, and have not shared information on their activities with, or been able to access information from, other National Health Service (NHS) healthcare providers. The development of services such as the Electronic Prescription Service and the Summary Care Record in England have helped to connect community pharmacy with the NHS infrastructure, and more comprehensive systems and datasets are proposed to integrate community pharmacy with the NHS in future. This paper will review the benefits of the connected community pharmacy, based on developments to date and reviewing evidence from other countries. It will describe some of the future developments that will support the connected community pharmacy in England, and discuss some of the implications for pharmacists and health policy makers.