The Role of a Self-Directed Technology to Improve Medication Adherence in Heart Failure Patients

doi:10.1016/j.nurpra.2014.08.011

The Journal for Nurse Practitioners

Volume 10, Issue 10, November–December 2014, Pages 856-863

https://doi.org/10.1016/j.nurpra.2014.08.011 Get rights and content

Highlights

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We explored the use of a self-directed medical technology to improve medication adherence.
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Technology-based strategies have potential to improve medication adherence

Abstract

Medication nonadherence contributes to poor outcomes in patients with heart failure. The purpose of this project was to determine whether a self-directed, web-based medical technology, MyMedSchedule.com^®, could improve medication adherence. Thirty-three heart failure patients participated in a pre/post-intervention exploratory design. A self-directed technology did not significantly improve medication adherence, z = −1.661, P = .097 (pre-intervention scores, mean = 6.44, SD = 1.38; post-intervention scores, mean = 6.89, SD = 1.09); however, participants expressed comfort (82%), satisfaction (75%), and confidence (75%) using the technology. Other positive outcomes were also identified. Technology-based strategies have the potential to improve adherence and reduce poor outcomes.

Section snippets

Background

Heart failure (HF), a costly complex chronic syndrome affecting over 6 million adults in the United States, is characterized by high mortality, frequent hospitalization, and reduced quality of life.¹ Nonadherence with HF medications has been cited as a major contributing factor to these patient outcomes.2, 3 Affordability, knowledge about medications, patients’ attitudes and beliefs, depression, age, forgetfulness, and complex scheduled regimens are cited as barriers to medication adherence.4, 5

Methods

The project used a pre/post-intervention design. Thirty-three adult HF patients were purposively selected nonrandomly from an HF-DMP with an expected minimum of 30 participants. No power analysis for sample size was performed based on the nature of the evidence-based project, time-frame for the project, and number of patients seen daily in the HF-DMP program. This number was feasible because 17 to 27 patients are seen weekly in the HF-DMP. Selection criteria included: (a) ability to read,

Results

The aim of this pilot project was to explore the use of technology to improve medication adherence and the feasibility and acceptance in using MyMedSchedule.com^®. Participants included 33 pre–MMAS-8 and 28 post–MMAS-8 scores and HF Feasibility-Acceptance responses. Ages ranged from 28 to 85 years, with a mean age of 58.4 years (SD = 15.72 years), with 27% of participants over 70 years of age. Participants were mostly male (72.7%), living with someone (78%), and Stage C HF with an EF <40%

Discussion

A self-directed technology, MyMedSchedule.com^®, improved adherence to prescribed HF medication regimes of some participants. Affordability, age, and complexity of medication regime did not appear to be barriers to medication adherence in this sample. Participants reported positive responses after utilizing the medication adherence application. A high degree of acceptance and satisfaction was also found in those over age 70. This is consistent with the findings in the literature.¹⁵ Studies have

Implications

MyMedSchedule.com^® is an easy-to-use, technology-based intervention showing promise as an adjunct to improve medication adherence. Participants were able to access their medications instantly at home or on the go (eg, traveling or health-care provider appointments) to create, update, or view their schedule. Medication changes made using MedActionPlan™ could be retrieved immediately, thereby ensuring clients had a current list of medications. Medication nonadherence is complex and

Limitations

The MMAS-8 medication adherence tool relies on patient recall and memory. Patient self-reports are prone to inaccuracies, recall bias, and elicitation of socially acceptable responses.18, 23 The small sample size and sampling technique, purposively selected, decreased the participants’ population representation and increased the risk of sampling bias. The time-frame between participant program visits averaged 2 to 6 weeks, which limited participants’ reminders to use all features of the //MyMedSchedule.com

Conclusions

HF is a chronic complex clinical syndrome associated with increased risk for hospitalization, readmissions, emergency room visits, outpatient visits, and death.1, 36 Poor adherence to prescribed HF medications contributes to these outcomes.2, 7 Technology-based interventions have been utilized as an adjunct to improve medication adherence in patients with HF.⁸ The use of a self-directed technology, MyMedSchedule.com^®, did not significantly improve medication adherence in HF patients in this

Cynthia M. Walker, DNP, APRN, is an heart failure nurse practitioner at the Via Christi Hospital in Wichita, KS. She can be reached at [email protected].

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Cited by (9)

Effect and usability of mobile health applications for medication adherence in patients with heart failure: A systematic review
2023, International Journal of Medical Informatics
This review aimed to evaluate the effect of mobile health applications (apps) use on medication adherence in heart failure (HF) patients, and to verify their quality of use.
We searched MEDLINE, Embase, Web of Science, Scopus, CINAHL, LILACS, Cochrane, Clinical Trial Registries, Google Scholar, ProQuest, Open Access Theses and dissertations (OATD), Annual Symposium Proceedings of the American Medical Informatics Association (AMIA).
Of the 836 records identified, eight studies (five randomized clinical trials (RCTs) and three observational studies) were included, totaling 484 participants, with a mean age ranging from 51.1 to 72 years and 65% were male. The apps improved medication adherence when compared with their comparators in only two RCTs (n = 111, Cohen d = 3.23, 95% confidence interval (CI) 2.66; 3.80 and n = 80, d = 1.20, 95% CI 0.71; 1.66), and two observational studies, one of them with large effect size (n = 142, Cohen d = 1.51, 95% CI 1.12; 1.90). Apps proved to be more effective interventions than their comparators allowed continuous monitoring of patients. All included studies used self-report measures to assess medication adherence behaviors and their results should be interpreted with caution, as such tools may cause social desirability bias or recall bias.
The included studies indicate a possible outcome in favor of the use of apps to improve medication adherence in HF patients, but with very low quality level of evidence. Further studies are needed to investigate the effects of the use of apps, optimal frequency and duration of its use in HF patients.
CONSIGNELA: A multidisciplinary patient-centered project to improve drug prescription comprehension and execution in elderly people and parkinsonian patients
2018, Telematics and Informatics
Citation Excerpt :
Some studies found positive adherence effects whereas others did not. For instance, a study conducted by Walker et al. (2014) with 33 heart failure patients during a three-month period showed that MyMedSchedule.com was well-accepted by most of patients but did not reveal significant effects on patient adherence. Conversely, a significant positive effect was found on medication adherence with the Parkinson ́s Tracker App in a multicenter study conducted with 158 PD patients (Lakshminarayana et al., 2017).
Many older patients and patients with Parkinson’s disease (PD) do not respect medication prescriptions. Non-adherence is caused by several factors among which three play an important role: Treatment complexity, cognitive decline, and patient-provider communication. This article presents an ongoing multidisciplinary project, the CONSIGNELA project, which adopts a patient-centered approach for improving medication adherence in these patients. The first objective of the project is to identify the best way to communicate medication prescriptions with tablets and touch-screen devices. The second objective is to improve medication adherence by creating a collaborative application (app) designed both for older and PD patients and for healthcare professionals in charge of them. Two solutions are combined: A cognitive and a technological solutions. The cognitive solution consists in studying in real time older and PD patients while consulting and executing prescriptions presented in different formats to select the most efficient one. The technological solution aims to improve collaboration between health professionals and patients by developing System of Systems (SoS). The research model used in the project includes three phases. Only the results of phase 1 are presented in the article. A research app, CONSIGNELA-Appli-R was programmed to analyze patient cognitive processes while consulting a prescription on a tablet. A pilot study was carried out with young adults to test it. It confirmed a facilitating effect of table format. In parallel, the prototype of a second app, CONSIGNELA-Appli-P, for patients and healthcare providers was developed. It is based on an SoS architecture connecting a virtual pillbox, a Multi-Agent System (MAS) and a knowledge platform. The virtual pillbox is used by patients and providers to improve mutual understanding of medication prescriptions. The MAS provides agents that extract and analyze indicators, actions and information resulting from the interaction between patients and virtual pillboxes. All the information is capitalized and stored in the knowledge platform. Providers can receive charts and dashboards showing information about the following of the medication regimen, for instance, if patients are following it correctly or not.
A wearable sensor system for medication adherence prediction
2016, Artificial Intelligence in Medicine
Citation Excerpt :
As direct methods are generally unsuitable for regular use in home environment, we primarily focus our discussion and comparison on indirect methods. Several smartphone apps such as MyMedSchedule, MyMeds, and RxmindMe, provide advanced functionality for medication reminders [16–18]. These applications issue reminders, allow users to manually enter their dosage information, and record when they have taken their medication.
Studies have revealed that non-adherence to prescribed medication can lead to hospital readmissions, clinical complications, and other negative patient outcomes. Though many techniques have been proposed to improve patient adherence rates, they suffer from low accuracy. Our objective is to develop and test a novel system for assessment of medication adherence.
Recently, several smart pill bottle technologies have been proposed, which can detect when the bottle has been opened, and even when a pill has been retrieved. However, very few systems can determine if the pill is subsequently ingested or discarded. We propose a system for detecting user adherence to medication using a smart necklace, capable of determining if the medication has been ingested based on the skin movement in the lower part of the neck during a swallow. This, coupled with existing medication adherence systems that detect when medicine is removed from the bottle, can detect a broader range of use-cases with respect to medication adherence.
Using Bayesian networks, we were able to correctly classify between chewable vitamins, saliva swallows, medication capsules, speaking, and drinking water, with average precision and recall of 90.17% and 88.9%, respectively. A total of 135 instances were classified from a total of 20 subjects.
Our experimental evaluations confirm the accuracy of the piezoelectric necklace for detecting medicine swallows and disambiguating them from related actions. Further studies in real-world conditions are necessary to evaluate the efficacy of the proposed scheme.
The impact of mobile applications on medication adherence: A systematic review
2020, Translational Behavioral Medicine
Mobile-based technology for the management of chronic diseases in the elderly: A feasibility study
2019, Current Aging Science
CARMIE: A conversational medication assistant for heart failure
2017, International Journal of E-Health and Medical Communications

View all citing articles on Scopus

Cynthia M. Walker, DNP, APRN, is an heart failure nurse practitioner at the Via Christi Hospital in Wichita, KS. She can be reached at [email protected].

Betty L. Elder, PhD, RN, is an associate professor in the School of Nursing at Wichita State University.

Karen S. Hayes, PhD, APRN, is an associate professor in the School of Nursing at Wichita State University.

: In compliance with national ethical guidelines, the authors report no relationships with business or industry that would pose a conflict of interest.

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Brief ReportThe Role of a Self-Directed Technology to Improve Medication Adherence in Heart Failure Patients

Highlights

Abstract

Section snippets

Background

Methods

Results

Discussion

Implications

Limitations

Conclusions

Am J Cardiol

Mayo Clin Proc

J Card Fail

J Am Pharm Assoc

Rev Esp Cardiol

Intern J Cardiol

Am J Cardiol

J Am Pharm Assoc

Heart disease and stroke statistics—2012 update: a report from the American Heart Association

Circulation

Medication adherence and medicare expenditure among beneficiaries with heart failure

Am J Manag Care

Non-compliance in patients with heart failure; how can we manage it?

Eur J Heart Fail

HFSA 2010 comprehensive heart failure practice guideline

J Card Fail

Systematic review of studies on telemonitoring of patients with congestive heart failure: a meta-analysis

J Telemed Telecare

Interventions for enhancing medication adherence (review)

Cochrane Database Syst Rev

Real-time electronic adherence monitoring is feasible, comparable to unannounced pill counts, and acceptable

AIDS Behav

Reminder packaging for improving adherence to self-administered long-term medications

Cochrane Database Syst Rev

Telemonitoring in patients with heart failure

N Engl J Med

Interventions to improve adherence to self-administered medications for chronic diseases in the United States: a systematic review

Ann Intern Med

Brief Report
The Role of a Self-Directed Technology to Improve Medication Adherence in Heart Failure Patients