Developing and testing an electronic medication administration monitoring device for community dwelling seniors: a feasibility study

Henry Yu-Hin Siu, Dee Mangin, Michelle Howard, David Price, David Chan, Henry Yu-Hin Siu, Dee Mangin, Michelle Howard, David Price, David Chan

Abstract

Background: Medication non-adherence, polypharmacy, and adverse drug events are major healthcare issues leading to significant morbidity, mortality, and healthcare expenditures. Currently, there are no methods to systematically track medication usage in community-dwelling seniors. The eDosette prototype was created to make medication use patterns visible via the Internet. This study aims to demonstrate feasibility, usability, and acceptability of the eDosette in community-dwelling seniors in primary care.

Methods: A 2-week feasibility study involving a convenience sample of 10 patients from an academic family medicine teaching unit in Hamilton, Ontario, Canada, was conducted over a 6-month period between April and October 2015. The eDosette transmitted hourly electronic data via the Internet on each participant's pattern of medication use; this data was converted into an individualized medication administration record (MAR). Based on the MARs from the 10 participants, the frequency of missed medication doses, the time of dose administration, and each participant's adherence rate for their prescribed medications could be determined. A medication adherence survey and a patient usability and acceptability survey were administered to all the participants of the study.

Results: The eDosette was able to record a participant's medication use and transmit this data electronically via the Internet with sufficient quality to create participant-specific MARs. A total of 418 doses were captured by the eDosette throughout the study; only 5% (n = 22 doses) were missing information or had poor image quality. Analysis of the MARs revealed that 19% (n = 79 doses) were taken outside a 2-h window of the average dose administration time, and two doses were completely missed by all participants during this feasibility study. Participant feedback found the eDosette easy and acceptable to use. Participant feedback also identified hardware and software issues that require attention prior to a larger study.

Conclusions: The eDosette is a feasible and novel technology that can be successfully installed into the homes of community-dwelling seniors to help in monitoring actual medication use patterns. This study provided details for further device development and evidence to support the need for a larger pilot study on the eDosette's impact on medication adherence.

Keywords: Drug monitoring; Electronic; Medication adherence; Safety; Senior adults.

Figures

Fig. 1
Fig. 1
The various iterations of the eDosette prototype and their corresponding image data. a The first-generation, top-loading eDosette prototype that includes a side effect alert button and a medication disposal unit. b The first-generation, bottom-loading eDosette prototype that includes a side effect alert button and a medication disposal unit. c The second-generation, top-loading eDosette prototype that includes a side effect alert button and a medication disposal unit. d An example of the image captured by the first-generation top-loading eDosette prototype. e An example of the image captured by the first-generation bottom-loading eDosette prototype. f An example of the image captured by the second-generation top-loading eDosette prototype
Fig. 2
Fig. 2
Participant medication adherence during the feasibility study. Comparing medication adherence (i.e. the percentage of administered doses taken within the 2-h time window of the average dose administration time) data to number of daily dose administration for all 10 participants. The Medication Adherence Questionnaire [25] scores for each participant is also shown (0 = low self-rated adherence, 1–2 = medium self-rated adherence, 3–4 = high self-rated adherence)

References

    1. Mangin D, Heath I, Jamoulle M. Beyond diagnosis: rising to the multimorbidity challenge. BMJ. 2012;344:e3526. doi: 10.1136/bmj.e3526.
    1. McCarthy L, Dolovich L, Haq M, et al. Frequency of risk factors that potentially increase harm from medications in older adults receiving primary care. Can J Clin Pharmacol. 2007;14(3):e283–90.
    1. Wu C, Bell CM, Wodchis WP. Incidence and economic burden of adverse drug reactions among elderly patients in Ontario emergency departments: a retrospective study. Drug Saf. 2012;35(9):769–81. doi: 10.1007/BF03261973.
    1. Zed PJ, Abu-Laban RB, Balen RM, et al. Incidence, severity and preventability of medication-related visits to the emergency department: a prospective study. CMAJ. 2008;178(12):1563–9. doi: 10.1503/cmaj.071594.
    1. Vervloet M, Linn AJ, van Weert JC, et al. The effectiveness of interventions using electronic reminders to improve adherence to chronic medication: a systematic review of the literature. J Am Med Inform Assoc. 2012;19(5):696–704. doi: 10.1136/amiajnl-2011-000748.
    1. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353(5):487–97. doi: 10.1056/NEJMra050100.
    1. Stange D, Kriston L, von Wolff A, et al. Medication complexity, prescription behaviour and patient adherence at the interface between ambulatory and stationary medical care. Eur J Clin Pharmacol. 2013;69(3):573–80. doi: 10.1007/s00228-012-1342-2.
    1. Stange D, Kriston L, von-Wolff A, et al. Reducing cardiovascular medication complexity in a German university hospital: effects of a structured pharmaceutical management intervention on adherence. J Manag Care Pharm. 2013;19(5):396–407.
    1. Wong MC, Liu J, Zhou S, et al. The association between multimorbidity and poor adherence with cardiovascular medications. Int J Cardiol. 2014;177(2):477–82. doi: 10.1016/j.ijcard.2014.09.103.
    1. Banning M. A review of interventions used to improve adherence to medication in older people. Int J Nurs Stud. 2009;46(11):1505–15. doi: 10.1016/j.ijnurstu.2009.03.011.
    1. Nieuwlaat R, Wilczynski N, Navarro T, et al. Interventions for enhancing medication adherence. Cochrane Database Syst Rev. 2014;11:CD000011.
    1. Banning M. Older people and adherence with medication: a review of the literature. Int J Nurs Stud. 2008;45(10):1550–61. doi: 10.1016/j.ijnurstu.2008.02.009.
    1. La Caze A, Gujral G, Cottrell WN. How do we better translate adherence research into improvements in patient care? Int J Clin Pharm. 2014;36(1):10–4. doi: 10.1007/s11096-013-9869-6.
    1. Freigofas J, Seidling HM, Quinzler R, et al. Characteristics of medication schedules used by elderly ambulatory patients. Eur J Clin Pharmacol. 2015;71(9):1109–20. doi: 10.1007/s00228-015-1888-x.
    1. Mahtani KR, Heneghan CJ, Glasziou PP, et al. Reminder packaging for improving adherence to self-administered long-term medications. Cochrane Database Syst Rev. 2011;9:CD005025.
    1. Goldstein CM, Gathright EC, Dolansky MA, et al. Randomized controlled feasibility trial of two telemedicine medication reminder systems for older adults with heart failure. J Telemed Telecare. 2014;20(6):293–9. doi: 10.1177/1357633X14541039.
    1. Arnet I, Walter PN, Hersberger KE. Polymedication Electronic Monitoring System (POEMS)—a new technology for measuring adherence. Front Pharmacol. 2013;4:26. doi: 10.3389/fphar.2013.00026.
    1. Mistry N, Keepanasseril A, Wilczynski NL, et al. Technology-mediated interventions for enhancing medication adherence. J Am Med Inform Assoc. 2015;22(e1):e177–93. doi: 10.1093/jamia/ocu047.
    1. George J, Elliott RA, Stewart DC. A systematic review of interventions to improve medication taking in elderly patients prescribed multiple medications. Drugs Aging. 2008;25(4):307–24. doi: 10.2165/00002512-200825040-00004.
    1. Zolnierek KB, Dimatteo MR. Physician communication and patient adherence to treatment: a meta-analysis. Med Care. 2009;47(8):826–34. doi: 10.1097/MLR.0b013e31819a5acc.
    1. Wilson IB, Schoen C, Neuman P, et al. Physician-patient communication about prescription medication nonadherence: a 50-state study of America’s seniors. J Gen Intern Med. 2007;22(1):6–12. doi: 10.1007/s11606-006-0093-0.
    1. Richard C, Lussier MT. Nature and frequency of exchanges on medications during primary care encounters. Patient Educ Couns. 2006;64(1-3):207–16. doi: 10.1016/j.pec.2006.02.003.
    1. Canadian Internet use survey. 2012. . Accessed 28 Jan 2016.
    1. Older adults and technology use: April 2014. . Accessed 31 May 2016.
    1. Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24(1):67–74. doi: 10.1097/00005650-198601000-00007.
    1. Raspberry Pi Organization. . Accessed 26 May 2016.
    1. Vrijens B, Vincze G, Kristanto P, et al. Adherence to prescribed antihypertensive drug treatments: longitudinal study of electronically compiled dosing histories. BMJ. 2008;336(7653):1114–7. doi: 10.1136/bmj.39553.670231.25.
    1. Morisky DE, Ang A, Krousel-Wood M, et al. Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens (Greenwich) 2008;10(5):348–54. doi: 10.1111/j.1751-7176.2008.07572.x.
    1. Bowcutt M, Rosenkoetter MM, Chernecky CC, et al. Implementation of an intravenous medication infusion pump system: implications for nursing. J Nurs Manag. 2008;16(2):188–97. doi: 10.1111/j.1365-2834.2007.00809.x.
    1. DiMatteo MR. Variations in patients’ adherence to medical recommendations: a quantitative review of 50 years of research. Med Care. 2004;42(3):200–9. doi: 10.1097/01.mlr.0000114908.90348.f9.
    1. van Dulmen S, Sluijs E, van Dijk L, et al. Patient adherence to medical treatment: a review of reviews. BMC Health Serv Res. 2007;7:55. doi: 10.1186/1472-6963-7-55.
    1. Roth MT, Ivey JL. Self-reported medication use in community-residing older adults: a pilot study. Am J Geriatr Pharmacother. 2005;3(3):196–204. doi: 10.1016/S1543-5946(05)80026-1.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する