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

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 (<i>P</i>&lt;.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 &gt; 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.

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

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.

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

2020 ◽  
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.

scholarly journals Stakeholder Feedback of Electronic Medication Adherence Products: Qualitative Analysis

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.

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

10.2196/18073 ◽  
2020 ◽  
Vol 22 (6) ◽  
pp. e18073 ◽  
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.

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

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; <i>P</i>=.03) and eNNOVEA Weekly Planner with Advanced Auto Reminder (mean 78.13, SD 14.13; <i>P</i>=.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; <i>P</i>=.03), e-pill MedGlider home medication management system (28.43, SD 20.80; <i>P</i>=.02), and eNNOVEA (28.65, SD 14.97; <i>P</i>=.03). The e-pill MedTime Station automatic pill dispenser with tipper (71.77, SD 21.98) had significantly more workload than TimerCap (<i>P</i>=.04), MedGlider (<i>P</i>=.03), and eNNOVEA (<i>P</i>=.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.

Efficacy of Taping for the Treatment of Plantar Fasciosis

2010 ◽  
Vol 100 (1) ◽  
pp. 41-51 ◽  
Author(s):  
Alexander T. M. van de Water ◽  
Caroline M. Speksnijder
Keyword(s):  
Health Care Providers ◽  
Clinical Relevance ◽  
Methodological Quality ◽  
Evidence Synthesis ◽  
Plantar Fascia ◽  
Controlled Trials ◽  
Care Providers ◽  
Short Term ◽  
Best Evidence Synthesis ◽  
Evidence Database

Background: The proximal insertional disorder of the plantar fascia is plantar fasciosis. Although plantar fasciosis is frequently seen by different health-care providers, indistinctness of etiology and pathogenesis is still present. A variety of interventions are seen in clinical practice. Taping constructions are frequently used for the treatment of plantar fasciosis. However, a systematic review assessing the efficacy of this therapy modality is not available. Methods: To assess the efficacy of a taping construction as an intervention or as part of an intervention in patients with plantar fasciosis on pain and disability, controlled trials were searched for in CINAHL, EMBASE, MEDLINE, Cochrane CENTRAL, and PEDro using a specific search strategy. The Physiotherapy Evidence Database scale was used to judge methodological quality. Clinical relevance was assessed with five specific questions. A best-evidence synthesis consisting of five levels of evidence was applied for qualitative analysis. Results: Five controlled trials met the inclusion criteria. Three trials with high methodological quality and of clinical relevance contributed to the best-evidence synthesis. The findings were strong evidence of pain improvement at 1-week follow-up, inconclusive results for change in level of disability in the short term, and indicative findings that the addition of taping on stretching exercises has a surplus value. Conclusions: There is limited evidence that taping can reduce pain in the short term in patients with plantar fasciosis. The effect on disability is inconclusive. (J Am Podiatr Med Assoc 100(1): 41–51, 2010)

Depression: A Long-Term Illness

1994 ◽  
Vol 165 (S26) ◽  
pp. 9-15 ◽  
Author(s):  
Martin B. Keller
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Maintenance Treatment ◽  
Depressive Disorders ◽  
Care Providers ◽  
Serious Illness ◽  
Antidepressant Treatments ◽  
Continued Education ◽  
Low Levels

The realisation that major depression is often both chronic and recurrent has slowly begun to change the way that depression is diagnosed and treated. In particular, the need for continuation and maintenance treatment is an issue that now deserves increased attention, especially with the availability of new classes of antidepressant treatments, which have excellent efficacy and more favourable side-effect profiles. Although the serious consequences of depressive disorders clearly indicate the need for effective and prompt intervention on the part of clinicians, the results of several studies indicate that patients with depression consistently receive no or low levels of antidepressant therapy. It is hoped that, through continued education of health care providers and patients about the consequences of depression, the issue of undertreatment of this serious illness will be resolved.

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

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.

scholarly journals “Take the treatment and be brave”: Care experiences of pregnant women with rifampicin-resistant tuberculosis

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0242604
Author(s):  
Marian Loveday ◽  
Sindisiwe Hlangu ◽  
Jennifer Furin
Keyword(s):  
Health Care ◽  
Pregnant Women ◽  
Health Care System ◽  
Health Care Providers ◽  
Physical Symptoms ◽  
Coding System ◽  
Care Providers ◽  
Convenience Sample ◽  
Care System

Background There are few data on the on the care experiences of pregnant women with rifampicin-resistant TB. Objective To describe the treatment journeys of pregnant women with RR-TB—including how their care experiences shape their identities—and identify areas in which tailored interventions are needed. Methods In this qualitative study in-depth interviews were conducted among a convenience sample from a population of pregnant women receiving treatment for RR-TB. This paper follows COREQ guidelines. A thematic network analysis using an inductive approach was performed to analyze the interview transcripts and notes. The analysis was iterative and a coding system developed which focused on the care experiences of the women and how these experiences affected their perceptions of themselves, their children, and the health care system in which treatment was received. Results Seventeen women were interviewed. The women described multiple challenges in their treatment journeys which required them to demonstrate sustained resilience (i.e. to “be brave”). Care experiences required them to negotiate seemingly contradictory identities as both new mothers—“givers of life”—and RR-TB patients facing a complicated and potentially deadly disease. In terms of their “pregnancy identity” and “RR-TB patient identity” that emerged as part of their care experiences, four key themes were identified that appeared to have elements that were contradictory to one another (contradictory areas). These included: 1) the experience of physical symptoms or changes; 2) the experience of the “mothering” and “patient” roles; 3) the experience of the care they received for their pregnancy and their RR-TB; and 4) the experience of community engagement. There were also three areas that overlapped with both roles and during which identity was negotiated/reinforced and they included: 1) faith; 2) socioeconomic issues; and 3) long-term concerns over the child’s health. At times, the health care system exacerbated these challenges as the women were not given the support they needed by health care providers who were ill-informed or angry and treated the women in a discriminatory fashion. Left to negotiate this confusing time period, the women turned to faith, their own mothers, and the fathers of their unborn children. Conclusion The care experiences of the women who participated in this study highlight several gaps in the current health care system that must be better addressed in both TB and perinatal services in order to improve the therapeutic journeys for pregnant women with RR-TB and their children. Suggestions for optimizing care include the provision of integrated services, including specialized counseling as well as training for health care providers; engagement of peer support networks; provision of socioeconomic support; long-term medical care/follow-up for children born to women who were treated for RR-TB; and inclusion of faith-based services in the provision of care.

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