1 / 64

Adherence Tools of Yesterday, Today and Tomorrow

Explore adherence terminologies, risk factors, traditional and modern tools, and technologies to monitor medication adherence for improved patient outcomes.

lgerardo
Download Presentation

Adherence Tools of Yesterday, Today and Tomorrow

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Adherence Tools of Yesterday, Today and Tomorrow Seth Heldenbrand, Pharm.D. Associate Professor University of Arkansas for Medical Sciences

  2. Disclosure • Financial disclosures • I have no financial conflicts to disclose

  3. Objectives • Summarize adherence terminology/epidemiology • Identify risk factors for non-adherence and tools to measure it • Evaluate traditional methods used to improve/monitor medication adherence • Review today’s technologies for improving/monitoring medication adherence • Summarize tomorrow’s technologies for improving/monitoring medication adherence

  4. Definition of Adherence • Compliance • “the extent to which a patient’s behavior matches the prescriber’s recommendation” • Adherence • “the extent to which the patient’s behavior matches the agreed upon prescriber’s recommendation” Fine RN, et al. Nonadherence Consensus Conference Summary Report; American Journal of Transplantation 2009; 9: 35–41

  5. So What Is Nonadherence (NA)? • “Deviation from the prescribed medication regimen sufficient to influence adversely the regimen’s intended effect”. Fine RN, et al. Nonadherence Consensus Conference Summary Report; American Journal of Transplantation 2009; 9: 35–41

  6. NA In the U.S. • Adversely affects health • Negative impact on relationship with health care provider • Skew results of clinical trials • Increases health resource consumption

  7. Epidemiology of NA • General population • 33-69% of medication related hospitalizations • $100 billion annually • Adherence to chronic medications is approximately 50% Dayer, L., Heldenbrand, S., Anderson, P., Gubbins, P. O., & Martin, B. C. (2013). Smartphone medication adherence apps: potential benefits to patients and providers. Journal of the American Pharmacists Association, 53(2), 172-181.

  8. Measurement of Adherence • Direct • Observation of ingestion • Physical or electronic • Indirect • Patient self-reports • Pill counts • Refill rates • Blood monitoring • Electronic monitoring What are the drawbacks to these indirect methods?

  9. Types of NA • Intentional • Rational decision • Beliefs/feelings • Unintentional • Intending to take the medication • Forgetfulness • Carelessness • Financial

  10. Risk Factors for NA • History of NA • Psychiatric illness • Personality disorders • Substance abuse • Adolescence • Chronic illness • Physician communication • Illiteracy • Low self efficacy • Side effects • Cost • Complex regimen • Poor aftercare/discharge • Negative beliefs in medications • Socioeconomic status • History of abuse • Race/culture Fine RN, et al. Nonadherence Consensus Conference Summary Report; American Journal of Transplantation 2009; 9: 35–41

  11. Methods to Improve Adherence • Behavioral • Reminder systems • Educational • Counseling reinforcement • Organizational • Decreasing regimen complexity • Removing barriers • $$$

  12. Medication Adherence Aids • Traditional • Best for unintentional NA • Pill boxes, unit-of-use packaging, alarms • Minimally involves patient in the process • Provide no adherence data • Many are passive systems

  13. Behavioral Interventions • Patient education • Best method to improve adherence • Especially for those taking more than six medications • Emotional intelligence • Motivational interviewing

  14. New and Emerging Adherence Technologies • Mobile Adherence Applications “Apps” • Internet-connected adherence monitoring technologies • Electronic and biometric ingestion confirming technologies

  15. Improving Adherence In Your Patients • NA is multifactorial • Interventions should be customized for each patient and pattern of NA • Foundation should be educational and behavior modifying • Multiple approaches should be used simultaneously

  16. Traditional Adherence Tools

  17. Traditional Adherence Tools • Counseling/Education • Regimen books “black books” • Regimen print outs • Administration check lists • Pill boxes (and other pill reminder tools)

  18. Counseling/Education • Time intensive • Health literacy concerns • Communication skills (YOURS and theirs) • Knowledge of health topics (YOURS and theirs) • Culture • Barriers to health system/care • Demands of situation/context • Education in non-health areas (reading, math, general education level)

  19. Clear Communication • Warm greeting • Eye contact • Plain, non-medical language • Slow down • Limit content (3-5 points) • Repeat key points • Graphics (when applicable) • Patient participation • Teach-back

  20. Teach-back Method • What percentage of medical information if forgotten immediately • 40-80% • What percentage of information retained is incorrect? • Almost 50% • Teach-back involves asking the patient to repeat what you have just told them • Repeat the process until they get it right • Confirms patient understanding of instructions

  21. Teach-back Method • Not a test of the patient knowledge • It is a test of how well you explained the concept • Use with everyone • Even when you think they understood • Should be used by all medical staff • MD/RN/PharmD/everyone

  22. Follow-up with Patients • Monitoring health (BP, blood sugar, weight) • Reinforcing action plans • Assessing/Confirming adherence • Verifying follow-through on referrals • Communicating lab results

  23. “Black Books” • Contact info • Brand/Generic • Each med is a card • Pencil • Patient’s responsibility

  24. Medication Regimenswww.medactionplan.com • Brand and generic names • Pictures of the meds • Drug, strength, dose, time • Contact information www.medactionplan.com

  25. Administration Checklists • Continues inpatient administration procedure as an outpatient • Not for every patient • “Type A” comes to mind… www.medactionplan.com

  26. Traditional Reminders • Daily pillbox ($2.49) • Weekly pillboxes ($11.24) • Electronic pillboxes ($13.99) • Wearable digital reminder alarms ($139.95)

  27. Other Adherence Tools • Multi-Alarm Pocket ($39.95) • Multi-Alarm TimeCap ($29.95) • MEDglider 4 Alarm Pillbox ($45.95) • CompuMed Automated Dispenser ($895)

  28. Other Adherence Tools • MEMS 6 TrackCap($107 for TrackCap; $365 for reader) • SenticarePillStation($89 enrollment; $79 per month) • GlowCaps(discussed later)

  29. Mobile Adherence Technologies “Apps”

  30. J Am Pharm Assoc. 2013;53:172–181. doi: 10.1331/JAPhA.2013.12202

  31. Adherence Apps • Using a smartphone to improve adherence is still a novel approach • Consolidates health information onto one ubiquitous device • Little to no cost to the patient • Simplifies complex regimens • Literature on health and wellness is growing • Adherence data is lacking (although some promising results) J Am Pharm Assoc. 2013;53:172–181. doi: 10.1331/JAPhA.2013.12202

  32. 2012 App StudyValuable App Attributes • Online data entry • Complex instruction capable • Cloud data storage • Searchable database of medications • Sync/export/print data • Tracks missed and taken doses • Provider data input capable • Multi-platform app • HIPAA compliant • Multiple profile feature • Multilingual J Am Pharm Assoc. 2013;53:172–181. doi: 10.1331/JAPhA.2013.12202

  33. 2012 App Study Methods • Inclusion • iPhone, Android, Blackberry OSs • English language • Must generate reminders • Exclusion • Designed for one medication type • Designed single disease state • Lacked description of functionality J Am Pharm Assoc. 2013;53:172–181. doi: 10.1331/JAPhA.2013.12202

  34. 2012 App Study Results • 160 apps reviewed (147 unique) • Scored and ranked based on author point system • Ten highest ranked apps were tested on available operating systems • Apps were evaluated against developer claims J Am Pharm Assoc. 2013;53:172–181. doi: 10.1331/JAPhA.2013.12202

  35. J Am Pharm Assoc. 2013;53:172–181. doi: 10.1331/JAPhA.2013.12202

  36. 2012 Rank Post-testing • MyMedSchedule • MyMeds • MedSimple • Med Agenda (iOS only) • RxmindMe (iOS only) • Dosecast • TRxC (Beta) • MediMemory (iOS only) • PillManager • MedsIQ Individual/Multi-User (Android only) J Am Pharm Assoc. 2013;53:172–181. doi: 10.1331/JAPhA.2013.12202

  37. 2014 App Study (Preliminary) • Similar Inclusion and Exclusion criteria • Modified “important features” • Tested the top 100 scoring apps

  38. 2014 App Study (Preliminary) • 461 apps reviewed (329 unique) • Scored and ranked based on author point system • 100 highest ranked apps were tested on available operating systems • Apps were evaluated for real world performance against developer claims

  39. Total Apps 2012 - 2014

  40. Apps by OS 2012 - 2014

  41. 2014 App Study (Preliminary) • What did we learn? • The adherence app market place is exploding • It is difficult for patients to choose quality apps • Most “free” apps are not worth the effort • Limited functionality (bait apps) • Poorly finished • Packed with adds • False claims by developers

  42. Selecting the right app • Developing an adherence app website • Lets patient or provider select desired functions • Ranks apps by our features/testing formula by desired features • Eliminates the trial and error approach to medication adherence apps that exists now

  43. Future Directions for Apps • Growing smartphone use (55% in US) • 14-42% persons age 65 or older • Companion websites for patients and providers • Escalating reminder systems • Tailored reminder systems • Motivating reminders • Less intrusive reminders for the adherent patient J Am Pharm Assoc. 2013;53:172–181. doi: 10.1331/JAPhA.2013.12202

  44. Future Directions for Apps • Connectivity: Real-time adherence info • Interconnectivity: synced hospital info, discharge instructions, pharmacy records • Medical social networks: patient specified providers apps contact at NA thresholds • Integration with ingestion sensor systems: the “holy grail” of adherence measurement J Am Pharm Assoc. 2013;53:172–181. doi: 10.1331/JAPhA.2013.12202

  45. Emerging and Available Adherence Technologies

  46. GlowCapswww.glowcaps.com • Cellular (AT&T) • Caps communicate with base to track adherence • Progressive reminders • Light up (cap) • Light up (base) • Play ringtone • Call/text patient • Requests Rx refills • Weekly adherence report

  47. GlowCaps • Cost • $10 per cap • $15 per month AT&T • Results • Single study • Improved adherence from 71% to 98% • Other studies pending or unpublished • Current trials underway in transplant recipients

  48. 6 month study randomized (nearing completion and publication hopefully) • Once a day meds for HTN • 27% increase in adherence over the control group (early results) • Funded by GlowCaps

  49. Similar Electronic Cap Technologies • eCAP • Beeps and flashes • RFID communication • MEMS 6 TrackCap • Records • bottle openings • uploads via reader

More Related