Voice Assistant Reminders and the Latency of Scheduled Medication Use in Older Adults With Pain: Descriptive Feasibility Study (Preprint)

BACKGROUND Pain is difficult to manage in older adults. It has been recommended that pain management in older adults should include both nonpharmacologic and pharmacologic strategies. Unfortunately, nonadherence to pain medication is more prevalent than nonadherence to any other chronic disease treatment. Technology-based reminders have some benefit for medication adherence, but adherence behavior outcomes have mostly been verified by self-reports. OBJECTIVE We aimed to describe objective medication adherence and the latency of medication use after a voice assistant reminder prompted participants to take pain medications for chronic pain. METHODS A total of 15 older adults created a voice assistant reminder for taking scheduled pain medications. A subsample of 5 participants were randomly selected to participate in a feasibility study, in which a medication event monitoring system for pain medications was used to validate medication adherence as a health outcome. Data on the subsample’s self-assessed pain intensity, pain interference, concerns and necessity beliefs about pain medications, self-confidence in managing pain, and medication implementation adherence were analyzed. RESULTS In the 5 participants who used the medication event monitoring system, the overall latency between voice assistant reminder deployment and the medication event (ie, medication bottle cap opening) was 55 minutes. The absolute latency (before or after the reminder) varied among the participants. The shortest average time taken to open the cap after the reminder was 17 minutes, and the longest was 4.5 hours. Of the 168 voice assistant reminders for scheduled pain medications, 25 (14.6%) resulted in the opening of MEMS caps within 5 minutes of the reminder, and 107 (63.7%) resulted in the opening of MEMS caps within 30 minutes of the reminder. CONCLUSIONS Voice assistant reminders may help cue patients to take scheduled medications, but the timing of medication use may vary. The timing of medication use may influence treatment effectiveness. Tracking the absolute latency time of medication use may be a helpful method for assessing medication adherence. Medication event monitoring may provide additional insight into medication implementation adherence during the implementation of mobile health interventions.

Real-world adherence to non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation measured by an electronic medication event monitoring system

Background Non-vitamin K antagonist oral anticoagulants (NOACs) are recommended as first choice therapy for thrombo-embolic prevention in patients with non-valvular atrial fibrillation (AF) and an elevated CHA2DS2-VASc score. A critical determinant for both safety and effectiveness of NOAC treatment is adherence to the prescribed medication regimen. Real-life adherence is suboptimal for many cardiovascular drugs. Measuring and improving NOAC adherence is primordial for optimising AF care. Purpose We measured adherence to any of the four NOACs in a population of AF patients who participate to a clinical trial during which they received targeted education on AF and its treatment. Methods This analysis is part of a prospective, multicenter, randomized controlled trial which is currently ongoing at three Belgian hospitals (AF-EduCare study). Ambulatory or hospitalised AF patients of that trial, treated with a NOAC, and who received a short targeted education session about AF and NOAC therapy at initiation, form the study group of this analysis. Monitoring of NOAC intake was performed by an electronic Medication Event Monitoring System (MEMS), starting immediately after initiation of the study and the education session (for 3 months). A special cap fits on a medication bottle and records the exact date and time of bottle openings. An LCD screen on the cap displays the number of openings of the medication bottle over a period of 24 hours, providing feedback about the correct intake. Dabigatran was replaced by a proxy medication as Dabigatran should be stored in the original package in order to protect it from moisture. Regimen adherence was calculated as the number of days on which one bottle opening in case of Rivaroxaban or Edoxaban and two bottle openings in case of Apixaban or Dabigatran is/are registered, divided by the total number of monitored days and multiplied by 100. Results A total of 233 patients (mean age 71.0±7.7 years; 71.2% males; CHA2DS2-VASc score 3.4±1.5; mean duration of AF history 5.8±7.5 years) were given a MEMS. Of these patients 32.2%, 31.3%, 26.2% and 10.3% were respectively on Edoxaban, Apixaban, Rivaroxaban and Dabigatran. Regimen adherence for these NOACs was 95.9±9.3%, 91.6±13.7%, 95.6±5.6% and 94.0±7.1% respectively. Overall, 94.4% of the patients had an adherence >80% and 81.1% had an adherence >90%. Adherence for the once and twice daily regimens was 95.8±0.7% and 92.2±1.3%, respectively (p=0.0003; Mann-Whitney U test). Conclusions This is a first prospective study investigating adherence for all NOACs using electronic monitoring. In this sample of AF patients who underwent a targeted education session before the 3 month monitoring period, mean adherence to NOAC intake was >90% for all NOACS. This high adherence may be related to both the education and the use of MEMS, which provided direct feedback to the patient. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): The AF-EduCare study is a project supported by the Fund for Scientific Research, Flanders (T002917N).

Time Variability of Pain Medication Adherence: An Observational Study (Preprint)

BACKGROUND Pain is difficult to manage in older adults. Pain management in older adults has been recommended to include both nonpharmacologic and pharmacologic strategies. Unfortunately, nonadherence to pain medication is more prevalent than any other chronic disease treatment. Technology-based reminders have some benefit for medication adherence but is biased because behavior has been verified by self-report. OBJECTIVE The purpose of this study was to describe objective medication adherence and latency of medication use in a subsample of older adults that used a voice assistant reminder to take scheduled pain medications. METHODS This observational feasibility study was conducted in the homes of community-dwelling older adults. Of the 15 older adults using voice assistant reminders for pain medications, we randomly selected a subsample of participants to use a medication event monitoring system to observe medication adherence. We collected demographics, self-reported health history, and pain medication name, dose, and dose frequency. Baseline data were collected on pain severity and interference using the Brief Pain Inventory-SF; concern and necessity beliefs about pain medications using the Beliefs About Medicines Questionnaire; self-confidence in managing pain with the PROMIS Self-Efficacy for Managing Symptoms and medication adherence with a Medication Event Monitoring System. RESULTS Participants used pain medications to alleviate pain severity ranging from moderate to severe. Each participant had varying beliefs about pain medicines and self-efficacy in managing pain symptoms. Overall latency was 55 minutes. The absolute latency (before or after reminder) varied among the participants; the shortest average time was 17 minutes and the longest was 4.5 hours. Our results found that 15% of the pain medications were taken within 5 minutes over 60% were taken within 30 minutes. CONCLUSIONS Voice assistant reminders may help cue patients to take medications, but the timing of use may vary. It may be helpful to monitor the absolute timing of scheduled medication use as a part of medication adherence behaviors in older adults especially when frequent dosing is prescribed. CLINICALTRIAL Adherence, Pain Medications, Older Adults, Reminders, mHealth, Voice Assistants

ANALISIS FEASIBILITAS MEDICATION EVENT MONITORING SYSTEM CAP DALAM PENINGKATAN KEPATUHAN MINUM OBAT PADA ORANG DENGAN SKIZOFRENIA : A LITERATURE REVIEW

Pendahuluan: Pengobatan orang dengan skizofrenia memerlukan jangka waktu pengobatan yang panjang, meliputi terapi farmakologi maupun terapi psikososial. Kondisi ini memicu potensi terjadinya putus obat yang berakibat kekambuhan orang dengan skizofrenia. Berbagai upaya dilakukan untuk meningkatkan kepatuhan salah satunya dengan menggunakan teknologi. Salah satu inovasi teknologi tersebut adalah metode pengawasan kepatuhan menggunakan MEMS® cap. Alat ini digunakan untuk melakukan pengawasan kepatuhan minum obat secara elektronik. Metode: Metode penulisan menggunakan non systematic literature review. Hasil: MEMS® cap terbukti efektif digunakan di berbagai negara seperti di Eropa, Amerika, dan Asia dalam menjalankan fungsinya dalam pengawasan kepatuhan pengobatan klien skizofrenia. Kesimpulan: Teknologi (MEMS®) cap merupakan solusi dalam meningkatkan upaya kepatuhan minum obat pada orang dengan skizofrenia dan memudahkan tenaga kesehatan dalam mengawasi penggunaan obat yang dianjurkan. Teknologi ini memberikan kemudahan dengan menyediakan layanan penentuan dosis obat, waktu pengobatan, dan alarm pengingat.