How Health Care Professionals Evaluate a Digital Intervention to Improve Medication Adherence: Qualitative Exploratory Study

Background Adherence rates of preventative medication for cardiovascular disease (CVD) have been reported as 57%, and approximately 9% of all CVD events in Europe are attributable to poor medication adherence. Mobile health technologies, particularly mobile apps, have the potential to improve medication adherence and clinical outcomes. Objective The objective of this study is to assess the effects of mobile health care apps on medication adherence and health-related outcomes in patients with CVD. This study also evaluates apps’ functionality and usability and the involvement of health care professionals in their use. Methods Electronic databases (MEDLINE [Ovid], PubMed Central, Cochrane Library, CINAHL Plus, PsycINFO [Ovid], Embase [Ovid], and Google Scholar) were searched for randomized controlled trials (RCTs) to investigate app-based interventions aimed at improving medication adherence in patients with CVD. RCTs published in English from inception to January 2020 were reviewed. The Cochrane risk of bias tool was used to assess the included studies. Meta-analysis was performed for clinical outcomes and medication adherence, with meta-regression analysis used to evaluate the impact of app intervention duration on medication adherence. Results This study included 16 RCTs published within the last 6 years. In total, 12 RCTs reported medication adherence as the primary outcome, which is the most commonly self-reported adherence. The duration of the interventions ranged from 1 to 12 months, and sample sizes ranged from 24 to 412. Medication adherence rates showed statistically significant improvements in 9 RCTs when compared with the control, and meta-analysis of the 6 RCTs reporting continuous data showed a significant overall effect in favor of the app intervention (mean difference 0.90, 95% CI 0.03-1.78) with a high statistical heterogeneity (I2=93.32%). Moreover, 9 RCTs assessed clinical outcomes and reported an improvement in systolic blood pressure, diastolic blood pressure, total cholesterol, and low-density lipoprotein cholesterol levels in the intervention arm. Meta-analysis of these clinical outcomes from 6 RCTs favored app interventions, but none were significant. In the 7 trials evaluating app usability, all were found to be acceptable. There was a great variation in the app characteristics. A total of 10 RCTs involved health care professionals, mainly physicians and nurses, in the app-based interventions. The apps had mixed functionality: 2 used education, 7 delivered reminders, and 7 provided reminders in combination with educational support. Conclusions Apps tended to increase medication adherence, but interventions varied widely in design, content, and delivery. Apps have an acceptable degree of usability; yet the app characteristics conferring usability and effectiveness are ill-defined. Future large-scale studies should focus on identifying the essential active components of successful apps. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42019121385; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=121385

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Interventions Used by Health Care Professionals to Enhance Medication Adherence in Transplant Patients: A Survey of Current Clinical Practice

Progress in Transplantation ◽

10.1177/152692481102100412 ◽

2011 ◽

Vol 21 (4) ◽

pp. 322-331 ◽

Cited By ~ 15

Author(s):

Lut Berben ◽

Fabienne Dobbels ◽

Christiane Kugler ◽

Cynthia L. Russell ◽

Sabina De Geest

Keyword(s):

Health Care ◽

Medication Adherence ◽

Health Care Professionals ◽

Organ Transplant ◽

Educational Interventions ◽

Transplant Recipients ◽

Self Administration ◽

Improve Medication Adherence ◽

Transplant Patients ◽

Adherence Assessment

Context Although medication nonadherence is associated with severe complications including graft rejection and loss, its prevalence remains high among organ transplant recipients. Still, little information exists on clinical use of interventions to improve medication adherence. Objective To identify transplant health care professionals' methods of assessing medication adherence, classify the used interventions, and measure those interventions' perceived effectiveness. Design, Setting and Participants A 46-item questionnaire on adherence assessment and interventions was distributed at the 2010 International Transplant Nurses Society symposium in Germany. Data were analyzed by using descriptive statistics. Results Of 141 distributed questionnaires, 94 (67%) were returned. Respondents with no direct patient contact (9%, n = 8) were excluded. The most frequently used assessment strategy was patient self-reporting (60%, n = 52). On average, participants reported using 47% of the educational/cognitive, 44% of the counseling/behavioral, and 42% of the psychological/affective interventions listed. Training patients to self-administer medications and providing printed adherence information were the most frequently used interventions (79% each, n = 68), followed by providing printed medication instructions (69%, n = 59). Most respondents (90%, n = 77) reported combining interventions. The intervention perceived as most effective was medication self-administration training. Conclusion Although available alternatives are demonstrably more effective for enhancing medication adherence, this sample relied more on educational interventions.

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Mobile Apps to Improve Medication Adherence in Cardiovascular Disease: Systematic Review and Meta-analysis (Preprint)

10.2196/preprints.24190 ◽

2020 ◽

Author(s):

Shahd Al-Arkee ◽

Julie Mason ◽

Deirdre A Lane ◽

Larissa Fabritz ◽

Winnie Chua ◽

...

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

Health Care ◽

Medication Adherence ◽

Clinical Outcomes ◽

Mobile Health ◽

Health Care Professionals ◽

Mobile Apps ◽

Meta Analysis ◽

Improve Medication Adherence

BACKGROUND Adherence rates of preventative medication for cardiovascular disease (CVD) have been reported as 57%, and approximately 9% of all CVD events in Europe are attributable to poor medication adherence. Mobile health technologies, particularly mobile apps, have the potential to improve medication adherence and clinical outcomes. OBJECTIVE The objective of this study is to assess the effects of mobile health care apps on medication adherence and health-related outcomes in patients with CVD. This study also evaluates apps’ functionality and usability and the involvement of health care professionals in their use. METHODS Electronic databases (MEDLINE [Ovid], PubMed Central, Cochrane Library, CINAHL Plus, PsycINFO [Ovid], Embase [Ovid], and Google Scholar) were searched for randomized controlled trials (RCTs) to investigate app-based interventions aimed at improving medication adherence in patients with CVD. RCTs published in English from inception to January 2020 were reviewed. The Cochrane risk of bias tool was used to assess the included studies. Meta-analysis was performed for clinical outcomes and medication adherence, with meta-regression analysis used to evaluate the impact of app intervention duration on medication adherence. RESULTS This study included 16 RCTs published within the last 6 years. In total, 12 RCTs reported medication adherence as the primary outcome, which is the most commonly self-reported adherence. The duration of the interventions ranged from 1 to 12 months, and sample sizes ranged from 24 to 412. Medication adherence rates showed statistically significant improvements in 9 RCTs when compared with the control, and meta-analysis of the 6 RCTs reporting continuous data showed a significant overall effect in favor of the app intervention (mean difference 0.90, 95% CI 0.03-1.78) with a high statistical heterogeneity (I<sup>2</sup>=93.32%). Moreover, 9 RCTs assessed clinical outcomes and reported an improvement in systolic blood pressure, diastolic blood pressure, total cholesterol, and low-density lipoprotein cholesterol levels in the intervention arm. Meta-analysis of these clinical outcomes from 6 RCTs favored app interventions, but none were significant. In the 7 trials evaluating app usability, all were found to be acceptable. There was a great variation in the app characteristics. A total of 10 RCTs involved health care professionals, mainly physicians and nurses, in the app-based interventions. The apps had mixed functionality: 2 used education, 7 delivered reminders, and 7 provided reminders in combination with educational support. CONCLUSIONS Apps tended to increase medication adherence, but interventions varied widely in design, content, and delivery. Apps have an acceptable degree of usability; yet the app characteristics conferring usability and effectiveness are ill-defined. Future large-scale studies should focus on identifying the essential active components of successful apps. CLINICALTRIAL PROSPERO International Prospective Register of Systematic Reviews CRD42019121385; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=121385

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How Health Care Professionals Evaluate a Digital Intervention to Improve Medication Adherence: Qualitative Exploratory Study (Preprint)

10.2196/preprints.8948 ◽

2017 ◽

Author(s):

Karen Thomson ◽

Corline Brouwers ◽

Olga C Damman ◽

Martine C de Bruijne ◽

Danielle RM Timmermans ◽

...

Keyword(s):

Health Care ◽

Medication Adherence ◽

Patient Engagement ◽

Health Care Professionals ◽

Self Management ◽

Improve Medication Adherence ◽

Qualitative Thematic Analysis ◽

Novel Approach ◽

Perceived Impact ◽

The Impact

BACKGROUND Medication nonadherence poses a serious and a hard-to-tackle problem for many chronic diseases. Electronic health (eHealth) apps that foster patient engagement and shared decision making (SDM) may be a novel approach to improve medication adherence. OBJECTIVE The aim of this study was to investigate the perspective of health care professionals regarding a newly developed digital app aimed to improve medication adherence. Familial hypercholesterolemia (FH) was chosen as a case example. METHODS A Web-based prototype of the eHealth app—MIK—was codesigned with patients and health care professionals. After user tests with patients, we performed semistructured interviews and user tests with 12 physicians from 6 different hospitals to examine how the functionalities offered by MIK could assist physicians in their consultation and how they could be integrated into daily clinical practice. Qualitative thematic analysis was used to identify themes that covered the physicians’ evaluations. RESULTS On the basis of the interview data, 3 themes were identified, which were (1) perceived impact on patient-physician collaboration; (2) perceived impact on the patient’s understanding and self-management regarding medication adherence; and (3) perceived impact on clinical decisions and workflow. CONCLUSIONS The eHealth app MIK seems to have the potential to improve the consultation between the patient and the physician in terms of collaboration and patient engagement. The impact of eHealth apps based on the concept of SDM for improving medication-taking behavior and clinical outcomes is yet to be evaluated. Insights will be useful for further development of eHealth apps aimed at improving self-management by means of patient engagement and SDM.

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