Stakeholder Feedback of Electronic Medication Adherence Products: Qualitative Analysis (Preprint)

BACKGROUND Medication management among older adults continues to be a challenge, and innovative electronic medication adherence products have been developed to address this need. OBJECTIVE The aim of this study is to examine user experience with electronic medication adherence products, with particular emphasis on features, usefulness, and preferences. METHODS Older adults, caregivers, and health care providers tested the usability of 22 electronic medication adherence products. After testing 5 products, participants were invited to participate in a one-on-one interview to investigate their perceptions and experiences with the features, usefulness, and preference for electronic medication adherence products tested. The interviews were audio recorded, transcribed, and analyzed using exploratory inductive coding to generate themes. The first 13 interviews were independently coded by 2 researchers. The percentage agreement and Cohen kappa after analyzing those interviews were 79% and 0.79, respectively. A single researcher analyzed the remaining interviews. RESULTS Of the 37 participants, 21 (57%) were older adults, 5 (14%) were caregivers, and 11 (30%) were health care providers. The themes and subthemes generated from the qualitative analysis included product factors (subthemes: simplicity and product features, including availability and usability of alarms, portability, restricted access to medications, and storage capacity) and user factors (subthemes: sentiment, affordability, physical and cognitive capability, and technology literacy and learnability). CONCLUSIONS Electronic medication adherence products have the potential to enable independent medication management in older adults. The choice of a particular product should be made after considering individual preferences for product features, affordability, and the sentiment of the users. Older adults, caregivers, and health care providers prefer electronic medication adherence products that are simple to set up and use, are portable, have easy-to-access medication compartments, are secure, and have adequate storage capacity.

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Stakeholder Feedback of Electronic Medication Adherence Products: Qualitative Analysis

Journal of Medical Internet Research ◽

10.2196/18074 ◽

2020 ◽

Vol 22 (12) ◽

pp. e18074

Author(s):

Sadaf Faisal ◽

Jessica Ivo ◽

Aidan McDougall ◽

Tejal Patel

Keyword(s):

Older Adults ◽

Health Care ◽

Medication Adherence ◽

Qualitative Analysis ◽

Health Care Providers ◽

Storage Capacity ◽

Medication Management ◽

Technology Literacy ◽

Care Providers ◽

Product Features

Background Medication management among older adults continues to be a challenge, and innovative electronic medication adherence products have been developed to address this need. Objective The aim of this study is to examine user experience with electronic medication adherence products, with particular emphasis on features, usefulness, and preferences. Methods Older adults, caregivers, and health care providers tested the usability of 22 electronic medication adherence products. After testing 5 products, participants were invited to participate in a one-on-one interview to investigate their perceptions and experiences with the features, usefulness, and preference for electronic medication adherence products tested. The interviews were audio recorded, transcribed, and analyzed using exploratory inductive coding to generate themes. The first 13 interviews were independently coded by 2 researchers. The percentage agreement and Cohen kappa after analyzing those interviews were 79% and 0.79, respectively. A single researcher analyzed the remaining interviews. Results Of the 37 participants, 21 (57%) were older adults, 5 (14%) were caregivers, and 11 (30%) were health care providers. The themes and subthemes generated from the qualitative analysis included product factors (subthemes: simplicity and product features, including availability and usability of alarms, portability, restricted access to medications, and storage capacity) and user factors (subthemes: sentiment, affordability, physical and cognitive capability, and technology literacy and learnability). Conclusions Electronic medication adherence products have the potential to enable independent medication management in older adults. The choice of a particular product should be made after considering individual preferences for product features, affordability, and the sentiment of the users. Older adults, caregivers, and health care providers prefer electronic medication adherence products that are simple to set up and use, are portable, have easy-to-access medication compartments, are secure, and have adequate storage capacity.

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A Prospective Study of Usability and Workload of Electronic Medication Adherence Products by Older Adults, Caregivers, and Health Care Providers

Journal of Medical Internet Research ◽

10.2196/18073 ◽

2020 ◽

Vol 22 (6) ◽

pp. e18073 ◽

Cited By ~ 2

Author(s):

Tejal Patel ◽

Jessica Ivo ◽

Sadaf Faisal ◽

Aidan McDougall ◽

Jillian Carducci ◽

...

Keyword(s):

Older Adults ◽

Health Care ◽

Medication Adherence ◽

Health Care Providers ◽

Health Care Professionals ◽

Medication Management ◽

Care Providers ◽

User Friendliness ◽

System Usability Scale ◽

Nasa Tlx

Background A decreased capacity to self-manage medications results in nonadherence, medication errors, and drug-related problems in older adults. Previous research identified 80 electronic medication adherence products available to assist patients with self-management of medications. Unfortunately, the usability and workload of these products are unknown. Objective This study aimed to examine the usability and workload of a sample of electronic medication adherence products. Methods In a prospective, mixed methods study, a sample of older adults, health care professionals, and caregivers tested the usability and workload of 21 electronic medication adherence products. Each participant tested 5 products, one at a time, after which they completed the system usability scale (SUS) and NASA-task load index (NASA-TLX), instruments that measure the usability and workload involved in using a product. Higher SUS scores indicate more user-friendliness, whereas lower NASA-TLX raw scores indicate less workload when using a product. Results Electronic medication adherence products required a mean of 12.7 steps (range 5-20) for the appropriate use and took, on average, 15.19 min to complete the setup tasks (range 1-56). Participants were able to complete all steps without assistance 55.3% of the time (103 out of the 186 tests were completed by 39 participants; range 0%-100%). The mean SUS and NASA-TLX raw scores were 52.8 (SD 28.7; range 0-100) and 50.0 (SD 25.7; range 4.2-99.2), respectively, revealing significant variability among the electronic medication adherence products. The most user-friendly products were found to be TimerCap travel size (mean 78.67, SD 15.57; P=.03) and eNNOVEA Weekly Planner with Advanced Auto Reminder (mean 78.13, SD 14.13; P=.049) as compared with MedReady 1700 automated medication dispenser (mean 28.63, SD 21.24). Similarly, MedReady (72.92, SD 18.69) was found to be significantly more work intensive when compared with TimerCap (29.35, SD 20.35; P=.03), e-pill MedGlider home medication management system (28.43, SD 20.80; P=.02), and eNNOVEA (28.65, SD 14.97; P=.03). The e-pill MedTime Station automatic pill dispenser with tipper (71.77, SD 21.98) had significantly more workload than TimerCap (P=.04), MedGlider (P=.03), and eNNOVEA (P=.04). Conclusions This study demonstrated that variability exists in the usability and workload of different electronic medication adherence products among older adults, caregivers, and clinicians. With few studies having investigated the usability and workload of electronic medication adherence products, no benchmarks exist to compare the usability and workload of these products. However, our study highlights the need to assess the usability and workload of different products marketed to assist with medication taking and provides guidance to clinicians regarding electronic medication adherence product recommendations for their patients. Future development of electronic medication adherence products should ensure that the target populations of patients are able to use these products adequately to improve medication management.

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A Prospective Study of Usability and Workload of Electronic Medication Adherence Products by Older Adults, Caregivers, and Health Care Providers (Preprint)

10.2196/preprints.18073 ◽

2020 ◽

Author(s):

Tejal Patel ◽

Jessica Ivo ◽

Sadaf Faisal ◽

Aidan McDougall ◽

Jillian Carducci ◽

...

Keyword(s):

Older Adults ◽

Health Care ◽

Medication Adherence ◽

Health Care Providers ◽

Health Care Professionals ◽

Medication Management ◽

Care Providers ◽

User Friendliness ◽

System Usability Scale ◽

Nasa Tlx

BACKGROUND A decreased capacity to self-manage medications results in nonadherence, medication errors, and drug-related problems in older adults. Previous research identified 80 electronic medication adherence products available to assist patients with self-management of medications. Unfortunately, the usability and workload of these products are unknown. OBJECTIVE This study aimed to examine the usability and workload of a sample of electronic medication adherence products. METHODS In a prospective, mixed methods study, a sample of older adults, health care professionals, and caregivers tested the usability and workload of 21 electronic medication adherence products. Each participant tested 5 products, one at a time, after which they completed the system usability scale (SUS) and NASA-task load index (NASA-TLX), instruments that measure the usability and workload involved in using a product. Higher SUS scores indicate more user-friendliness, whereas lower NASA-TLX raw scores indicate less workload when using a product. RESULTS Electronic medication adherence products required a mean of 12.7 steps (range 5-20) for the appropriate use and took, on average, 15.19 min to complete the setup tasks (range 1-56). Participants were able to complete all steps without assistance 55.3% of the time (103 out of the 186 tests were completed by 39 participants; range 0%-100%). The mean SUS and NASA-TLX raw scores were 52.8 (SD 28.7; range 0-100) and 50.0 (SD 25.7; range 4.2-99.2), respectively, revealing significant variability among the electronic medication adherence products. The most user-friendly products were found to be TimerCap travel size (mean 78.67, SD 15.57; P=.03) and eNNOVEA Weekly Planner with Advanced Auto Reminder (mean 78.13, SD 14.13; P=.049) as compared with MedReady 1700 automated medication dispenser (mean 28.63, SD 21.24). Similarly, MedReady (72.92, SD 18.69) was found to be significantly more work intensive when compared with TimerCap (29.35, SD 20.35; P=.03), e-pill MedGlider home medication management system (28.43, SD 20.80; P=.02), and eNNOVEA (28.65, SD 14.97; P=.03). The e-pill MedTime Station automatic pill dispenser with tipper (71.77, SD 21.98) had significantly more workload than TimerCap (P=.04), MedGlider (P=.03), and eNNOVEA (P=.04). CONCLUSIONS This study demonstrated that variability exists in the usability and workload of different electronic medication adherence products among older adults, caregivers, and clinicians. With few studies having investigated the usability and workload of electronic medication adherence products, no benchmarks exist to compare the usability and workload of these products. However, our study highlights the need to assess the usability and workload of different products marketed to assist with medication taking and provides guidance to clinicians regarding electronic medication adherence product recommendations for their patients. Future development of electronic medication adherence products should ensure that the target populations of patients are able to use these products adequately to improve medication management.

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Effect of Interactive eHealth Interventions on Improving Medication Adherence in Adults With Long-Term Medication: Systematic Review

Journal of Medical Internet Research ◽

10.2196/18901 ◽

2021 ◽

Vol 23 (1) ◽

pp. e18901

Author(s):

Bart P H Pouls ◽

Johanna E Vriezekolk ◽

Charlotte L Bekker ◽

Annemiek J Linn ◽

Hein A W van Onzenoort ◽

...

Keyword(s):

Health Care ◽

Medication Adherence ◽

Health Care Providers ◽

Evidence Synthesis ◽

Medication Management ◽

Care Providers ◽

Management Skills ◽

Best Evidence Synthesis ◽

Positive Effect

Background Medication nonadherence leads to suboptimal treatment outcomes, making it a major priority in health care. eHealth provides an opportunity to offer medication adherence interventions with minimal effort from health care providers whose time and resources are limited. Objective The aim of this systematic review is twofold: (1) to evaluate effectiveness of recently developed and tested interactive eHealth (including mHealth) interventions on medication adherence in adult patients using long-term medication and (2) to describe strategies among effective interventions. Methods MEDLINE, EMBASE, Cochrane Library, PsycINFO, and Web of Science were systematically searched from January 2014 to July 2019 as well as reference lists and citations of included articles. Eligible studies fulfilled the following inclusion criteria: (1) randomized controlled trial with a usual care control group; (2) a total sample size of at least 50 adult patients using long-term medication; (3) applying an interactive eHealth intervention aimed at the patient or patient’s caregiver; and (4) medication adherence as primary outcome. Methodologic quality was assessed using the Cochrane risk of bias tool. Selection and quality assessment of studies were performed by 2 researchers (BP and BvdB or JV) independently. A best evidence synthesis was performed according to the Cochrane Back Review Group. Results Of the 9047 records screened, 22 randomized clinical trials were included reporting on 29 interventions. Most (21/29, 72%) interventions specified using a (mobile) phone for calling, SMS text messaging, or mobile apps. A majority of all interactive interventions (17/29) had a statistically significant effect on medication adherence (P<.05). Of these interventions, 9 had at least a small effect size (Cohen d ≥ 0.2) and 3 showed strong odds for becoming adherent in the intervention group (odds ratio > 2.0). Our best evidence synthesis provided strong evidence for a positive effect of interventions using SMS text messages or interactive voice response, mobile app, and calls as mode of providing adherence tele-feedback. Intervention strategies “to teach medication management skills,” “to improve health care quality by coordinating medication adherence care between professionals,” and “to facilitate communication or decision making between patients and health care providers” also showed strong evidence for a positive effect. Conclusions Overall, this review supports the hypothesis that interactive eHealth interventions can be effective in improving medication adherence. Intervention strategies that improve patients’ treatment involvement and their medication management skills are most promising and should be considered for implementation in practice.

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Effect of Interactive eHealth Interventions on Improving Medication Adherence in Adults With Long-Term Medication: Systematic Review (Preprint)

10.2196/preprints.18901 ◽

2020 ◽

Author(s):

Bart P H Pouls ◽

Johanna E Vriezekolk ◽

Charlotte L Bekker ◽

Annemiek J Linn ◽

Hein A W van Onzenoort ◽

...

Keyword(s):

Health Care ◽

Medication Adherence ◽

Health Care Providers ◽

Evidence Synthesis ◽

Medication Management ◽

Care Providers ◽

Management Skills ◽

Best Evidence Synthesis ◽

Positive Effect

BACKGROUND Medication nonadherence leads to suboptimal treatment outcomes, making it a major priority in health care. eHealth provides an opportunity to offer medication adherence interventions with minimal effort from health care providers whose time and resources are limited. OBJECTIVE The aim of this systematic review is twofold: (1) to evaluate effectiveness of recently developed and tested interactive eHealth (including mHealth) interventions on medication adherence in adult patients using long-term medication and (2) to describe strategies among effective interventions. METHODS MEDLINE, EMBASE, Cochrane Library, PsycINFO, and Web of Science were systematically searched from January 2014 to July 2019 as well as reference lists and citations of included articles. Eligible studies fulfilled the following inclusion criteria: (1) randomized controlled trial with a usual care control group; (2) a total sample size of at least 50 adult patients using long-term medication; (3) applying an interactive eHealth intervention aimed at the patient or patient’s caregiver; and (4) medication adherence as primary outcome. Methodologic quality was assessed using the Cochrane risk of bias tool. Selection and quality assessment of studies were performed by 2 researchers (BP and BvdB or JV) independently. A best evidence synthesis was performed according to the Cochrane Back Review Group. RESULTS Of the 9047 records screened, 22 randomized clinical trials were included reporting on 29 interventions. Most (21/29, 72%) interventions specified using a (mobile) phone for calling, SMS text messaging, or mobile apps. A majority of all interactive interventions (17/29) had a statistically significant effect on medication adherence (P<.05). Of these interventions, 9 had at least a small effect size (Cohen d ≥ 0.2) and 3 showed strong odds for becoming adherent in the intervention group (odds ratio > 2.0). Our best evidence synthesis provided strong evidence for a positive effect of interventions using SMS text messages or interactive voice response, mobile app, and calls as mode of providing adherence tele-feedback. Intervention strategies “to teach medication management skills,” “to improve health care quality by coordinating medication adherence care between professionals,” and “to facilitate communication or decision making between patients and health care providers” also showed strong evidence for a positive effect. CONCLUSIONS Overall, this review supports the hypothesis that interactive eHealth interventions can be effective in improving medication adherence. Intervention strategies that improve patients’ treatment involvement and their medication management skills are most promising and should be considered for implementation in practice.

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Nurse Practitioners’ Experiences of Polypharmacy in Community-Dwelling Older Adults

Innovation in Aging ◽

10.1093/geroni/igaa057.670 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 207-207

Author(s):

Christine Pariseault ◽

Nancy Sharts-Hopko ◽

Elizabeth Blunt

Keyword(s):

Older Adults ◽

Health Care ◽

Older Adult ◽

Health Care Providers ◽

Nurse Practitioners ◽

Adult Population ◽

Medication Management ◽

Community Dwelling ◽

Care Providers ◽

Adequate Care

Abstract Numerous studies exist that define polypharmacy and its impact on health. Additionally, the literature is rich in studies documenting the benefits of care provided by nurse practitioners. A gap in research exists at the intersection of the value of nurse practitioners in caring for older adults and their management of polypharmacy. Coinciding with a growth of America’s older adult population and the need for adequate care, the purpose of this study was to explore the experiences of nurse practitioners caring for older adults experiencing polypharmacy. A qualitative descriptive study was conducted using a purposive sampling of nurse practitioners who care for older adults. Interviews were conducted and data was analyzed for themes. Four themes emerged: defining polypharmacy, communicating and collaborating, clinical judgement of nurse practitioners in relation to polypharmacy, and medication issues of older adults. Major themes emerged that depict the complexity of medication management in older adults as well as the important role of NPs in providing care to older adults. The significance of the study findings to future practice includes improving communication and collaboration of prescribing health care providers, better identification and management of polypharmacy, and improving the health care delivered to older adults. Safe and effective prescribing for older adults requires NPs consider the unique needs of each older adult while utilizing technology to support collaboration and decision making.

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Interdisciplinary Therapy Assessments for the Older Adult

Perspectives on Gerontology ◽

10.1044/gero17.1.11 ◽

2012 ◽

Vol 17 (1) ◽

pp. 11-16

Author(s):

Lynn Chatfield ◽

Sandra Christos ◽

Michael McGregor

Keyword(s):

Older Adults ◽

Health Care ◽

Standardized Testing ◽

Health Care Providers ◽

Outcome Measurement ◽

Care Providers ◽

Patient Centered ◽

Screening Process ◽

Evidenced Based ◽

Changing Economy

In a changing economy and a changing industry, health care providers need to complete thorough, comprehensive, and efficient assessments that provide both an accurate depiction of the patient's deficits and a blueprint to the path of treatment for older adults. Through standardized testing and observations as well as the goals and evidenced-based treatment plans we have devised, health care providers can maximize outcomes and the functional levels of patients. In this article, we review an interdisciplinary assessment that involves speech-language pathology, occupational therapy, physical therapy, and respiratory therapy to work with older adults in health care settings. Using the approach, we will examine the benefits of collaboration between disciplines, an interdisciplinary screening process, and the importance of sharing information from comprehensive discipline-specific evaluations. We also will discuss the importance of having an understanding of the varied scopes of practice, the utilization of outcome measurement tools, and a patient-centered assessment approach to care.

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New Syphilis Cases in Older Adults, 2004–2019: An Analysis of Surveillance Data From South China

Frontiers in Medicine ◽

10.3389/fmed.2021.781759 ◽

2021 ◽

Vol 8 ◽

Author(s):

Cheng Wang ◽

Peizhen Zhao ◽

Mingzhou Xiong ◽

Joseph D. Tucker ◽

Jason J. Ong ◽

...

Keyword(s):

Older Adults ◽

Health Care ◽

Health Care Providers ◽

Temporal Trends ◽

Health Concern ◽

Targeted Prevention ◽

Care Providers ◽

Annual Percent Change ◽

Syphilis Infection ◽

Over Time

Background: Sexual health among older adults is a major public health concern globally. The syphilis burden is increasing in older adults in China. This study aimed to describe factors associated with syphilis infection and diagnosis among older adults in China during a 16 year period.Methods: Using 16 years of data (2004–2019) from the syphilis case report system of Guangdong, China, we compared data from older adults (aged ≥50 years) with those from younger people (aged 15–49 years). We compared the two age group with the Chi-square test for difference, and Joinpoint regression models to assess the temporal trends.Results: During the study period, 242,115 new syphilis diagnoses were reported in older adults. The mean notification rate of new diagnoses was 64.1 per 100,000 population across the entire 16-year period, which significantly increased over time (average annual percent change [AAPC] 16.2%, 95% CI 13.7–18.7). Syphilis diagnoses increased significantly over time among less developed cities and older women. In 2019, compared with younger adults, newly diagnosed older adults were more likely to be male, native to reporting city, had unknown transmission routes, and were diagnosed late.Conclusion: Our findings call for an urgent need to deliver more targeted prevention interventions for older adults, such as strengthen awareness among health care providers, and integration of syphilis services and primary health care for older adults.

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The Effect of the E-Patuh Application on HIV/Aids Patients’ Adherence in Consuming Antiretroviral

Jurnal Keperawatan Padjadjaran ◽

10.24198/jkp.v7i1.809 ◽

2019 ◽

Vol 7 (1) ◽

Author(s):

Alfian Alfian ◽

Kusman Ibrahim ◽

Imas Rafiyah

Keyword(s):

Health Care ◽

Medication Adherence ◽

Health Care Providers ◽

Antiretroviral Treatment ◽

Intervention Group ◽

Self Report ◽

Care Providers ◽

Aids Patients ◽

Antiretroviral Adherence ◽

Hiv Aids

Medication adherence is behavior that refers to client obeys in following a medication, and makes lifestyle changes in accordance of recommendations from health care providers. Antiretroviral adherence is paramount for HIV/AIDS patients. The effects were often a problem in antiretroviral treatment and toxicity and often be the reason for replacing or stopping antiretroviral treatment. This study aimed to determine the “E-Patuh” Applications effect on antiretroviral adherence in patients Of HIV/AIDS In West Java. The research design was a quasi-experimental with nonequivalent control group design. The location of this research was in RSUD Kota Bandung and in RSUD Kota Banjar. The respondents was selected without randomization and used purposive sampling technique. Respondents in this study were 30 respondents. Data were obtained using self-report questionnaires. The intervention group was monitored a 30-day android-based E-Patuh application and monitored on an E-Patuh website and then measured adherence value with self-report. Data were analyzed using SPSS 22 with chi-square test. The results showed a significant difference between adherence value before and after application of E-Patuh in the intervention group with (p <0.05) with obtained p value = 0,006. The results of this study prove a positive effect on the using of E-Patuh applications against ARV medication adherence in the intervention group with the support system of the E-Patuh application. The used of E-Patuh is helpful in improving ARV adherence in HIV/AIDS patients. The features contained in E-Patuh were directly reminiscent of the timing of taking medication for PWLH. E-Patuh should be consideration for PLHIV and health care providers in hospitals to improve ARV adherence to reduce mortality rates in people living with HIV.

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Improving Medication Management by Understanding Patient and Caregiver Preferences for Medication Packaging

The Senior Care Pharmacist ◽

10.4140/tcp.n.2020.447. ◽

2020 ◽

Vol 35 (10) ◽

pp. 446-464

Author(s):

Joshua Chou ◽

Merton Lee ◽

Taylor Kaminsky ◽

Tarlan Namvar ◽

Catherine E. Cooke ◽

...

Keyword(s):

Health Care ◽

Health Care Providers ◽

Health Care Professionals ◽

Medication Management ◽

The United States ◽

Community Dwelling ◽

Care Providers ◽

Font Size ◽

Visual Appearance ◽

June July

OBJECTIVE: To assess older adults' perceptions and preferences when comparing multi-medication packaging products. DESIGN: Qualitative study involving focus group interviews (FGIs) and key informant interviews (KIIs). SETTING: Interviews were conducted in multiple cities within the United States during June-July 2019. PATIENTS, PARTICIPANTS: FGI participants (N=36) included community dwelling adults, 65 years of age or older, who took 5+ chronic medications, or their caregivers. KII participants (N=15) included health care professionals caring for similar populations. INTERVENTIONS: Participants were given samples of blister packs and pouches and asked about medication management and appearance and usability of medication packaging. Interviews were audio-recorded with participants' consent, then transcribed and coded using Atlas. ti. Recurrent and emergent themes were identified, and selected quotes served as examples of identified themes. MAIN OUTCOME MEASURE: Participants' perceptions regarding medication packaging. RESULTS: Participants' preferences varied for different multi-medication packaging systems. Similarly, most FGI participants did not communicate a strong attitude for or against their existing management systems. However, many FGI participants perceived a need for larger font size than seen on the either of the multimedication packaging samples. KII participants also preferred a larger font size on both packagings. KII participants thought the blister packs offered better visual organization and enabled caregivers to quickly assess adherence. However, KII participants expressed concern about integrating as-needed and short-term use medications and noted difficulty opening both types of packages. CONCLUSION: Visual appearance is important to both patients and health care providers. Continued research in this area is vital for tailoring packaging types and technology to patients.

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