scholarly journals The relationship between objective app engagement and medication adherence in asthma and COPD: a retrospective analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Leanne Kaye ◽  
Rahul Gondalia ◽  
Alesha Thompson ◽  
David A. Stempel ◽  
Meredith A. Barrett
Keyword(s):  
Medication Adherence ◽  
Digital Health ◽  
Medication Use ◽  
Self Management ◽  
Smartphone App ◽  
Management Platform ◽  
Session Duration ◽  
Controller Medication ◽  
Controller Medications ◽  
The Relationship

AbstractDigital health tools can promote disease self-management, but the association of smartphone app engagement and medication adherence is unclear. We assessed the relationship between objective smartphone app engagement and controller medication use in adults with asthma and COPD. We retrospectively analyzed data from participants enrolled in a digital self-management platform for asthma and COPD. Eligible adults had a smartphone and a paired electronic medication monitor (EMM). Longitudinal, mixed-effects logistic regressions estimated the relationship between daily app engagement (app opens, session duration) and daily controller medication use. Data from 2309 participants (71% asthma; 29% COPD) was analyzed. Opening the app (vs. not opening the app) was associated with significantly greater odds (OR (95% CI)) of using controller medications in asthma (2.08 (1.98, 2.19)) and COPD (1.61 (1.49, 1.75). Longer session duration was also associated with greater odds of using controller medications in asthma and COPD, but the odds of use attenuated with longer session duration in COPD. This study presents a novel assessment of the relationship between objectively-measured smartphone app engagement and controller medication use in asthma and COPD. Such insights may help develop targeted digital health tools and interventions.

scholarly journals Medication Errors in Adolescents Using Asthma Controller Medications

2020 ◽  
Vol 7 ◽  
pp. 2333794X2098134
Author(s):  
Henry Clark ◽  
Delesha Carpenter ◽  
Kathleen Walsh ◽  
Scott A. Davis ◽  
Nacire Garcia ◽  
...  
Keyword(s):  
Medical Record ◽  
Medication Errors ◽  
Medication Use ◽  
Persistent Asthma ◽  
Cross Sectional Study ◽  
Asthma Medication ◽  
Sectional Study ◽  
Cross Sectional ◽  
Controller Medication ◽  
Controller Medications

The purpose of this study was to describe the number and types of errors that adolescents and caregivers report making when using asthma controller medications. A total of 319 adolescents ages 11 to 17 with persistent asthma and their caregivers participated in this cross-sectional study. Adolescent and caregiver reports of asthma medication use were compared to the prescribed directions in the medical record. An error was defined as discrepancies between reported use and the prescribed directions. About 38% of adolescents reported 1 error in using asthma controller medications, 16% reported 2 errors, and 5% reported 3 or more errors. About 42% of caregivers reported 1 error in adolescents using asthma controller medications, 14% reported 2 errors, while 6% reported 3 or more errors. The type of error most frequently reported by both was not taking the medication at all. Providers should ask open-ended questions of adolescents with asthma during visits so they can detect and educate families on how to overcome errors in taking controller medication use.

scholarly journals The Association Between Medication Adherence for Chronic Conditions and Digital Health Activity Tracking: Retrospective Analysis

10.2196/11486 ◽  
2019 ◽  
Vol 21 (3) ◽  
pp. e11486 ◽  
Author(s):  
Tom Quisel ◽  
Luca Foschini ◽  
Susan M Zbikowski ◽  
Jessie L Juusola
Keyword(s):  
Health Care ◽  
Medication Adherence ◽  
Health Outcomes ◽  
Fixed Effects ◽  
Digital Health ◽  
Positive Association ◽  
Activity Tracking ◽  
Pharmacy Claims ◽  
The Relationship ◽  
Age And Sex

Background Chronic diseases have a widespread impact on health outcomes and costs in the United States. Heart disease and diabetes are among the biggest cost burdens on the health care system. Adherence to medication is associated with better health outcomes and lower total health care costs for individuals with these conditions, but the relationship between medication adherence and health activity behavior has not been explored extensively. Objective The aim of this study was to examine the relationship between medication adherence and health behaviors among a large population of insured individuals with hypertension, diabetes, and dyslipidemia. Methods We conducted a retrospective analysis of health status, behaviors, and medication adherence from medical and pharmacy claims and health behavior data. Adherence was measured in terms of proportion of days covered (PDC), calculated from pharmacy claims using both a fixed and variable denominator methodology. Individuals were considered adherent if their PDC was at least 0.80. We used step counts, sleep, weight, and food log data that were transmitted through devices that individuals linked. We computed metrics on the frequency of tracking and the extent to which individuals engaged in each tracking activity. Finally, we used logistic regression to model the relationship between adherent status and the activity-tracking metrics, including age and sex as fixed effects. Results We identified 117,765 cases with diabetes, 317,340 with dyslipidemia, and 673,428 with hypertension between January 1, 2015 and June 1, 2016 in available data sources. Average fixed and variable PDC for all individuals ranged from 0.673 to 0.917 for diabetes, 0.756 to 0.921 for dyslipidemia, and 0.756 to 0.929 for hypertension. A subgroup of 8553 cases also had health behavior data (eg, activity-tracker data). On the basis of these data, individuals who tracked steps, sleep, weight, or diet were significantly more likely to be adherent to medication than those who did not track any activities in both the fixed methodology (odds ratio, OR 1.33, 95% CI 1.29-1.36) and variable methodology (OR 1.37, 95% CI 1.32-1.43), with age and sex as fixed effects. Furthermore, there was a positive association between frequency of activity tracking and medication adherence. In the logistic regression model, increasing the adjusted tracking ratio by 0.5 increased the fixed adherent status OR by a factor of 1.11 (95% CI 1.06-1.16). Finally, we found a positive association between number of steps and adherent status when controlling for age and sex. Conclusions Adopters of digital health activity trackers tend to be more adherent to hypertension, diabetes, and dyslipidemia medications, and adherence increases with tracking frequency. This suggests that there may be value in examining new ways to further promote medication adherence through programs that incentivize health tracking and leveraging insights derived from connected devices to improve health outcomes.

Using Intervention Mapping to develop a decision support system-based smartphone app to support self-management of non-specific low back pain (SELFBACK) (Preprint)

2020 ◽  
Author(s):  
Malene Jagd Svendsen ◽  
Louise Fleng Sandal ◽  
Per Kjær ◽  
Barbara I Nicholl ◽  
Kay Cooper ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Digital Health ◽  
Intervention Mapping ◽  
Complex Interventions ◽  
Health Interventions ◽  
Self Management ◽  
Smartphone App ◽  
Low Back ◽  
Intervention Content

BACKGROUND International guidelines consistently endorse promotion of self-management for people with low back pain (LBP), however, implementation of these guidelines remains a challenge. Digital health interventions, such as those that can be provided by smartphone apps, have been proposed as a promising mode to support self-management in people with chronic conditions including LBP. However, the evidence base for digital health interventions to support self-management of LBP is weak and detailed description and documentation of the intervention is lacking. Structured Intervention Mapping (IM) constitutes a six-step process that can be used to guide the development of complex interventions. OBJECTIVE The aim of this paper is to describe the IM process for designing and creating an app-based intervention designed to support self-management of non-specific LBP to reduce pain-related disability. METHODS Five steps of the IM process were systematically applied: the core processes included literature reviews, brainstorming and group discussions, and inclusion of stakeholders and representatives of the target population. Throughout a period of more than two years, the intervention content and technical features of delivery were created, tested and revised through user tests, feasibility studies and a pilot study. RESULTS One behavioural outcome was identified as the proxy for reaching the overall programme goal; increased use of evidence-based self-management strategies. Physical exercises, education and physical activity were the main components of the self-management intervention, designed and produced to be delivered via a smartphone app. All intervention content was theoretically underpinned by behaviour change theory and Normalization Process Theory. CONCLUSIONS We describe a detailed example of the application of the IM approach to the development of a theory-driven, complex, and digital intervention designed to support self-management of LBP. This description provides transparency of the developmental process of the intervention and a possible blue-print for designing and creating future digital health interventions for self-management.

scholarly journals Creating a Smartphone App for Caregivers of Children With Atopic Dermatitis With Caregivers, Health Care Professionals, and Digital Health Experts: Participatory Co-Design (Preprint)

2019 ◽  
Author(s):  
Xiaomeng Xu ◽  
Konstadina Griva ◽  
Mark Koh ◽  
Elaine Lum ◽  
Woan Shin Tan ◽  
...  
Keyword(s):  
Health Care ◽  
Atopic Dermatitis ◽  
Technology Acceptance ◽  
Health Care Professionals ◽  
Digital Health ◽  
Self Management ◽  
Smartphone App ◽  
Emotional Impact ◽  
Design Workshop ◽  
Health Experts

BACKGROUND Smartphone apps could support patients and caregivers in disease self-management. However, as patients’ experiences and needs might not always align with clinical judgments, the eliciting and engaging of perspectives of all stakeholders in the smartphone app design process is of paramount importance. OBJECTIVE The aims of this study are to better understand the needs of and challenges facing caregivers and health care professionals (HCPs) who care for children with atopic dermatitis (AD) and to explore the desirable features and content of a smartphone app that would support AD self-management. METHODS This study adopted a qualitative participatory co-design methodology involving 3 focus group discussions: workshop one focused on caregivers; workshop two engaged with HCPs; and in the last workshop, caregivers and digital health experts were asked to design the wireframe prototype. The participants completed a sociodemographic questionnaire, a technology acceptance questionnaire, and a workshop evaluation form. RESULTS Twelve caregivers participated in the first workshop, and 10 HCPs participated in the second workshop. Eight caregivers and 4 digital health experts attended the third workshop. Three superordinate themes that reflected caregivers’ and HCPs’ challenges and needs were identified: <i>empowerment by education, confusion over treatment</i>, and <i>emotional impact</i>. Workshop participants also raised a series of suggestions on the features and contents of the AD self-management app, which informed the last co-design workshop, and described their needs and challenges. In the last workshop, the participants developed a wireframe prototype of the app following the identified requirements and recommendations. CONCLUSIONS The co-design approach was found to be a successful way of engaging with the participants, as it allowed them to express their creativity and helped us to articulate the root of the clinical problems. The co-design workshop was successful in creating and generating new ideas and solutions for smartphone app development.

scholarly journals The Detroit Young Adult Asthma Project: Proposal for a Multicomponent Technology Intervention for African American Emerging Adults With Asthma (Preprint)

2017 ◽  
Author(s):  
Karen MacDonell ◽  
Sylvie Naar ◽  
Wanda Gibson-Scipio ◽  
Jean-Marie Bruzzese ◽  
Bo Wang ◽  
...  
Keyword(s):  
African American ◽  
Medication Adherence ◽  
Pilot Study ◽  
Emerging Adults ◽  
Asthma Management ◽  
Text Messages ◽  
Secondary Outcome ◽  
Minority Adolescents ◽  
Controller Medication ◽  
Controller Medications

BACKGROUND Racial and ethnic minority youth have poorer asthma status than white youth, even after controlling for socioeconomic variables. Proper use of asthma controller medications is critical in reducing asthma mortality and morbidity. The clinical consequences of poor asthma management include increased illness complications, excessive functional morbidity, and fatal asthma attacks. There are significant limitations in research on interventions to improve asthma management in racial minority populations, particularly minority adolescents and young adults, although illness management tends to deteriorate after adolescence during emerging adulthood, the unique developmental period beyond adolescence but before adulthood. OBJECTIVE The objective of the pilot study was to test the feasibility, acceptability, and signals of efficacy of an intervention targeting adherence to controller medication in African American youth (ages 18-29) with asthma. All elements of the protocol were piloted in a National Heart, Lung, and Blood Institute (NHLBI)–funded pilot study (1R34HL107664 MacDonell). Results suggested feasibility and acceptability of the protocol as well as proof of concept. We are now ready to test the intervention in a larger randomized clinical trial. METHODS The proposed study will include 192 African American emerging adults with moderate to severe persistent asthma and low controller medication adherence recruited from clinic, emergency department, and community settings. Half of the sample will be randomized to receive a multicomponent technology-based intervention targeting adherence to daily controller medication. The multicomponent technology-based intervention consists of 2 components: (1) 2 sessions of computer-delivered motivational interviewing targeting medication adherence and (2) individualized text messaging focused on medication adherence between the sessions. Text messages will be individualized based on ecological momentary assessment. The remaining participants will complete a series of computer-delivered asthma education modules matched for length, location, and method of delivery of the intervention session. Control participants will also receive text messages between intervention sessions. Message content will be the same for all control participants and contain general facts about asthma (not tailored). RESULTS It is hypothesized that youth randomized to multicomponent technology-based intervention will show improvements in medication adherence (primary outcome) and asthma control (secondary outcome) compared with comparison condition at all postintervention follow-ups (3, 6, 9, and 12 months). The proposed study was funded by NHLBI from September 1, 2016 through August 31, 2021. CONCLUSIONS This project will test a brief, technology-based intervention specifically targeting adherence to asthma controller medications in an under-researched population, African American emerging adults. If successful, our multicomponent technology-based intervention aimed at improving adherence to asthma medications has the potential to improve quality of life of minority emerging adults with asthma at relatively low cost. It could eventually be integrated into clinical settings and practice to reach a large number of emerging adults with asthma. CLINICALTRIAL ClinicalTrials.gov NCT03121157; https://clinicaltrials.gov/ct2/show/NCT03121157 (Archived by WebCite at http://www.webcitation.org/6wq4yWHPv)

scholarly journals Creating a Smartphone App for Caregivers of Children With Atopic Dermatitis With Caregivers, Health Care Professionals, and Digital Health Experts: Participatory Co-Design

10.2196/16898 ◽  
2020 ◽  
Vol 8 (10) ◽  
pp. e16898
Author(s):  
Xiaomeng Xu ◽  
Konstadina Griva ◽  
Mark Koh ◽  
Elaine Lum ◽  
Woan Shin Tan ◽  
...  
Keyword(s):  
Health Care ◽  
Atopic Dermatitis ◽  
Technology Acceptance ◽  
Health Care Professionals ◽  
Digital Health ◽  
Self Management ◽  
Smartphone App ◽  
Emotional Impact ◽  
Design Workshop ◽  
Health Experts

Background Smartphone apps could support patients and caregivers in disease self-management. However, as patients’ experiences and needs might not always align with clinical judgments, the eliciting and engaging of perspectives of all stakeholders in the smartphone app design process is of paramount importance. Objective The aims of this study are to better understand the needs of and challenges facing caregivers and health care professionals (HCPs) who care for children with atopic dermatitis (AD) and to explore the desirable features and content of a smartphone app that would support AD self-management. Methods This study adopted a qualitative participatory co-design methodology involving 3 focus group discussions: workshop one focused on caregivers; workshop two engaged with HCPs; and in the last workshop, caregivers and digital health experts were asked to design the wireframe prototype. The participants completed a sociodemographic questionnaire, a technology acceptance questionnaire, and a workshop evaluation form. Results Twelve caregivers participated in the first workshop, and 10 HCPs participated in the second workshop. Eight caregivers and 4 digital health experts attended the third workshop. Three superordinate themes that reflected caregivers’ and HCPs’ challenges and needs were identified: empowerment by education, confusion over treatment, and emotional impact. Workshop participants also raised a series of suggestions on the features and contents of the AD self-management app, which informed the last co-design workshop, and described their needs and challenges. In the last workshop, the participants developed a wireframe prototype of the app following the identified requirements and recommendations. Conclusions The co-design approach was found to be a successful way of engaging with the participants, as it allowed them to express their creativity and helped us to articulate the root of the clinical problems. The co-design workshop was successful in creating and generating new ideas and solutions for smartphone app development.

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