I am researching mobile applications for improving medication adherence among elderly cardiac patients in the United States. With increased penetration of mobile networks, and increased use among the elderly, mobile phone apps have been applied for improved adherence in a number of conditions including diabetes. I am looking for recommendations regarding specific apps and/or features. Also, would it be helpful if the app was connected to the healthcare provider? Are there any provider based reinforcement models?

 
Joaquin Blaya, PhD
Replied at 7:27 AM, 20 Nov 2013

Hi Riddhi,
This is a really good question because medication adherence is such an important part. There are many ways to look at this, the first is to try and measure the adherence directly through technology. From this point of view there are a few projects that I know of X out TB (http://healthmarketinnovations.org/program/x-out-tb) or smart pill boxes which transmit when a medication bottle has been opened (http://www.imedicalapps.com/2013/06/smart-pill-bottles-medication-adherence/).

I've created a startup to help patients with diabetes and hypertension and part of the problem is adherence, but we've taken the approach that you need to help and educate patients to take their medications rather than measure if they do. In other words, only a patient that knows and wants to take their medications will be adherent, so we created a system that calls and sends text messages to help with this and other problems. Here's a 3 minute video on it and I'm also attaching a paper describing similar interventions in 4 countries.
http://www.youtube.com/watch?v=ytd8sycSKkE

Is there a specific problem that you're trying to solve?

Have others implemented technologies for adherence that have worked?

Attached resource:

Debbie Coultis
Replied at 12:00 AM, 21 Nov 2013

Are there plans to include computing people with security and privacy
expertise? I gave a presentation about this a few weeks ago. It is
possible for a person to hack into an electronic device and do harm. I
would put monitoring a pacemaker or sugar level with a release in this
category. I would not put reminding a person to take medication via a cell
call or some other indicator too dangerous.

Many corporate and government websites to do not provide for security or
privacy. I don't think we want to complicate matters by adding a
healthcare component.

Joaquin Blaya, PhD
Replied at 4:57 AM, 21 Nov 2013

Hi Debbie,
Is your question addressed to my response? Because I don't quite understand
it because MiDoctor is all via phone calls and SMS, noone's mentioned
pacemakers or monitoring sugar levels.

Riddhi Doshi
Replied at 8:30 AM, 21 Nov 2013

Thanks Joaquinn. Those are very useful resources. You raise a very pertinent issue about education. My group is currently undertaking a pilot study in this area- we are taking two pronged approach on education-- educating the patients on the technology use (to reduce usability errors) and to educate the patients about the significance of the medication (to improve medication adherence). The education component is tricky because I haven't seen many publications on comparative effectiveness of different educational interventions exploring the how/what/when of materials to improve medication adherence. Please let me know if there is anything in the education area that you'd like to recommend.

The Mobile app component which I am exploring is a followup to the pilot. We are essentially trying to address the issue with medication adherence among cardiac patients who are on daily anticoagulants- hoping to generate a more generalizable solution to increase patients' overall medication adherence.

About the privacy and security issue raised by Debbie- a large number of healthcare IT companies are using mobile phone based applications- mostly because of the increased penetration and constant access- a patient is less likely use a computer as often as their mobile phone. I believe- if we use an existing mobile app product, the privacy and security shall be the responsibility of the company and not the researcher- though all precautions have to be taken at the research end to protect the same.

Joaquin Blaya, PhD
Replied at 6:41 AM, 22 Nov 2013

Riddhi,
Doing a pubmed search I found the following articles that might help.
You're right that there isn't much about how to do patient education (or at
least not much that I know about, there might be more in the
psychology/sociology literature)

Multifaceted Intervention to Improve Medication Adherence and Secondary
Prevention Measures After Acute Coronary Syndrome Hospital Discharge: A
Randomized Clinical Trial.
http://www.ncbi.nlm.nih.gov/pubmed/24247275

Feasibility and Effectiveness of Remote, Telephone-Based Delivery of Cardiac
Rehabilitation
http://www.ncbi.nlm.nih.gov/pubmed/24161003


also did a pubmed search on the following terms education cardiac patients
adherence systematic review (
http://www.ncbi.nlm.nih.gov/pubmed/?term=education+cardiac+patients+adherence...
)
and found some interesting articles.

For example,
Evaluation of a self-management patient education program for patients with
chronic heart failure undergoing inpatient cardiac rehabilitation: study
protocol of a cluster randomized controlled trial.
http://www.ncbi.nlm.nih.gov/pubmed/23968340

Barriers and facilitators to self-care in chronic heart failure: a
meta-synthesis of qualitative studies.
Videos to influence: a systematic review of effectiveness of video-based
education in modifying health behaviors.
Heart failure care management programs: a review of study interventions and
meta-analysis of outcomes

If you have trouble finding any one of them send me an email off list
and I can try and help.

Joaquín
___________________________________________________________________
Gerente de Desarrollo, eHealth Systems <http://www.ehs.cl/@@
Research Fellow, Escuela de Medicina de Harvard @@http://hms.harvard.edu/@@
Moderador, GHDOnline.org @@http://www.ghdonline.org/>

A/Prof. Terry HANNAN
Replied at 7:14 AM, 22 Nov 2013

This is an interesting discussion because we need to ask are elderly cardiac patients different from other elderly patients who have to take multiple medications e.g. diabetes, hypertension, Parkinson's Disease, etc.?
Here is an article I found (which may be in Joaquin's list) that defines core fundamentals of non compliance in the elderly even though it is focussed upon cardiac patients. From my readings complicance is a global problem and the non-compliance rates would appear the same in all chronic disease states. I stand to be corrected on these views. Terry
Medication Adherence: Its Importance in Cardiovascular Outcomes
P. Michael Ho, Chris L. Bryson and John S. Rumsfeld
Circulation. 2009;119:3028-3035
doi: 10.1161/CIRCULATIONAHA.108.768986
Circulation is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231 Copyright © 2009 American Heart Association, Inc. All rights reserved.
Print ISSN: 0009-7322. Online ISSN: 1524-4539

Debbie Coultis
Replied at 3:33 PM, 22 Nov 2013

Anything thing that has a microchip that can be programmed is of concern
for security an privacy breaches. This includes cellphones. To get more
technical, it includes refrigerators, microwave ovens and televisions.

Sarada V
Replied at 3:35 AM, 3 Mar 2014

Hi Riddhi,
I've just signed up on ghdonline and am not sure if you are still on the look-out for a mobile app that helps with medication adhrence and is connected to the healthcare provider.

We have recently launched Doc99 - A Patient Portal in a Mobile that lets patients carry out multiple transactions using their mobile phone.

The patient is able to receive interactive medication reminders on the mobile phone. The app requires that the patient responds to the reminder and the response chosen by the patient is visible to the healthcare provider.

For example, when the patient receives a medication reminder, they are asked to select one of the four options (customizable) listed below:
Taken
Not taken – had a reaction to the medicine
Not taken – run out of medication
Not taken – forgot

This ensures better prescription compliance.

The app also allows the patient to have an one-on-one interaction with the healthcare provider, through voice/ text chat (similar to WhatsApp). It also lets a patient send a photograph or video recording (wound area, physical symptoms, etc).

Thanks,

Sarada V
Aavanor Systems Pvt. Ltd

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