Reminders For Medication Adherence Research Articles

Features, functions, and quality of mobile applications for type 2 diabetes care in China: Systematic search of app stores

BackgroundType 2 diabetes (T2DM) is highly prevalent in China, affecting over 114 million people. While mHealth interventions have shown promise, there is limited research on T2DM management apps in real-world app stores. ObjectiveThis study aimed to systematically search and analyze T2DM care mobile apps in the Chinese market, describing their features, and functions, and evaluating the quality of the most popular apps using validated tools. MethodsWe conducted a comprehensive search in Chinese Android and iOS app stores for T2DM management apps. We downloaded 138 eligible ones for a general review of their key features and function. We also assessed the quality of the top 20 apps from both platforms using the Mobile App Rating Scale (MARS) by both researcher and patient. ResultsA total of 3524 apps were searched. 138 eligible apps were downloaded for general review and 29 popular apps were included for quality assessment. Most apps were designed for patient users (87.0 %) and developed by commercial companies (85.5 %). Common functions included blood glucose monitoring, diabetes education, integration with measuring devices, medication adherence reminders, teleconsultation services, and diabetes risk factor tracking. The researcher's evaluation yielded an average MARS score of 4.0 out of 5 for popular apps, with subscale scores of functionalities (4.5), aesthetics (4.1), engagement (3.7), and information (3.6). However, patient ratings were lower in functionality (3.5), aesthetics (3.4), and engagement (2.6), and the patient faced difficulties with information-related items. Similar trends were observed in subject quality items. ConclusionApp developers should engage caregivers, and family members as target users, and involve government agencies as partners to improve T2DM management apps. Future apps should incorporate scientifically proven advanced functions to enhance their effectiveness. The quality assessment highlighted weaknesses in engagement and information and the importance of user-centric approaches in app development.

Two-way SMS Reminders for Medication Adherence and Quality of Life in Adults with Type 2 Diabetes: A Randomized Controlled Tria

Non-adherence to a medication regime often has a negative impact on patient outcomes. With a relatively low cost, many countries are using short messaging services to reduce non-adherence rates. In Thailand, research using a short messaging service reminder for people to take their medications is understudied. This multi-center randomized controlled trial, 2-arm, parallel-group research aimed to determine the effects of 2-way SMS reminders on the medication adherence and quality of life of adults with type 2 diabetes mellitus. Data were collected from 63 participants with diabetes in a treatment group (33) and a control group (30). The sample consisted of adults aged 18 and older who were diagnosed with diabetes living in a northeast province of Thailand. All participants received standard care, but those in the treatment group also received a tailored 2-way short message service as a mobile health (mHealth) treatment for four months. Medication adherence was measured by the level of hemoglobin A1c. Quality of life was measured using the Thai version of a Quality-of-Life Questionnaire developed by the World Health Organization and the Diabetes-39 Questionnaire. Data were analyzed using descriptive statistics. One-way repeated measures ANOVA was used to compare hemoglobin A1c levels and quality of life mean scores across three-time points (0, 2, and 4 months). The results revealed that at the completion of the study, the participants in the treatment group had significantly lower hemoglobin A1c than those in the control group and significantly better health-related quality of life, demonstrating that the 2-way SMS reminder service improved their health outcomes. Thus, it is recommended that nurses should employ mHealth, such as 2-way SMS reminder solutions tailored to patients’ daily routines. A future investigation comparing the cost-effectiveness and patient outcomes of different mHealth technologies is suggested.

Patient and healthcare provider perspectives on adherence with antihypertensive medications: an exploratory qualitative study in Tanzania

BackgroundPoor medication adherence is an extraordinarily common problem worldwide that contributes to inadequate control of many chronic diseases, including Hypertension (HT). Globally, less than 14% of the estimated 1.4 billion patients with HT achieve optimal control. A myriad of barriers, across patient, healthcare provider, and system levels, contributes to poor medication adherence. Few studies have explored the reasons for poor medication adherence in Tanzania and other African countries.MethodsA qualitative study applying grounded theory principles was conducted in the catchment area of two semi-urban clinics in Dar es Salaam, Tanzania, to determine the perceived barriers to HT medication adherence. Ten key informant interviews were conducted with healthcare providers who manage HT patients. Patients diagnosed with HT (SBP ≥ 140 and DBP ≥ 90), were randomly selected from patient registers, and nine focus group discussions were conducted with a total 34 patients. Inductive codes were developed separately for the two groups, prior to analyzing key thematic ideas with smaller sub-categories.ResultsAffordability of antihypertensive medication and access to care emerged as the most important barriers. Fee subsidies for treatment and medication, along with health insurance, were mentioned as potential solutions to enhance access and adherence. Patient education and quality of physician counseling were mentioned by both providers and patients as major barriers to medication adherence, as most patients were unaware of their HT and often took medications only when symptomatic. Use of local herbal medicines was mentioned as an alternative to medications, as they were inexpensive, available, and culturally acceptable. Patient recommendations for improving adherence included community-based distribution of refills, SMS text reminders, and family support. Reliance on religious leaders over healthcare providers emerged as a potential means to promote adherence in some discussions.ConclusionsEffective management of hypertensive patients for medication adherence will require several context-specific measures. These include policy measures addressing financial access, with medication subsidies for the poor and accessible distribution systems for medication refill; physician measures to improve health provider counseling for patient centric care; and patient-level strategies with reminders for medication adherence in low resource settings.

Text Message Medication Adherence Reminders Automated and Delivered at Scale Across Two Institutions: Testing the Nudge System: Pilot Study.

Medication refill behavior in patients with cardiovascular diseases is suboptimal. Brief behavioral interventions called Nudges may impact medication refill behavior and can be delivered at scale to patients using text messaging. Patients who were prescribed and filled at least one medication for hypertension, hyperlipidemia, diabetes, atrial fibrillation, and coronary artery disease were identified for the pilot study. Patients eligible for the pilot (N=400) were enrolled with an opportunity to opt out. In phase I of the pilot, we tested text message delivery to 60 patients. In phase II, we tested intervention feasibility by identifying those with refill gap of ≥7 days and randomized them to intervention or control arms. Patients were texted Nudges and assessed whether they refilled their medications. Of 400 patients sent study invitations, 56 (14%) opted out. In phase I, we successfully delivered text messages to 58 of 60 patients and captured patient responses via text. In phase II, 207 of 286 (72.4%) patients had a medication gap ≥7 days for one or more cardiovascular medications and were randomized to intervention or control. Enrolled patients averaged 61.7 years old, were primarily male (69.1%) and White (72.5%) with hypertension being the most prevalent qualifying condition (78.7%). There was a trend towards intervention patients being more likely to refill at least 1 gapping medication (30.6% versus 18.0%; P=0.12) and all gapping medications (17.8% versus 10.0%; P=0.27). It is possible to set up automated processes within health care delivery systems to identify patients with gaps in medication adherence and send Nudges to facilitate medication refills. Text message Nudges could potentially be a feasible and effective method to facilitate medication refills. A large multi-site randomized trial to determine the impact of text-based Nudges on overall CVD morbidity and mortality is now underway to explore this further. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03973931.

Evaluating Reminders for Medication Adherence and Side Effects in M-Health Environment

Reminders are a very promising intervention for improving medication adherence in mobile health environment. From the published literature, this research find that effectiveness of reminders varies widely and side effects of reminders have not been studied. To address these, this article develops an analytical model to evaluate different types of reminders for medication adherence. The model is also used to estimate side effects of the reminders. The results indicate that context-aware reminders perform better than simple reminders in improving medication adherence for willing patients in mobile health environment. Simple and persistent reminders also lead to more side effects than context-aware reminders. The results of this study will be useful for patients, healthcare providers, researchers and policy makers in improved decision making for medication adherence. The future work can include development of smart reminders to meet different requirements of patients, healthcare professionals and payers in terms of personalization, performance, long-term effectiveness, reliability, and health outcomes.

An analytical model to evaluate reminders for medication adherence

ObjectivesSeveral interventions have been proposed to improve medication adherence including those using reminders. The performance of reminders, including effectiveness and side effects, varies widely in different settings. We must study this for improving decision making on how, when, and where to use what type of reminders. MethodsAnalytical modeling is an effective and low-cost method to derive preliminary or intermediate results and insights for further study of interventions for medication adherence. We developed an analytical model that can be used to evaluate the performance of reminders in various settings, including effectiveness, side effects, and healthcare cost savings for medication adherence. ResultsContext-aware reminders perform better than simple reminders for willing patients even when they completely rely on reminders for taking their doses. Simple reminders lead to more side effects than context-aware reminders. Further, context-aware reminders generate more healthcare savings without side effects and a comparable cost of the intervention. The results contribute to an improved understanding of reminders and are used to derive a set of guidelines for patients, healthcare professionals, decision-makers, and mobile app developers. ConclusionsThe proposed model is a low cost and effective tool to derive results and insights for the use of reminders in different settings to improve medication adherence. Therefore, the model can be utilized as a decision-making tool for deciding whether to pursue an RCT on healthcare interventions. The analytical model can be extended for complex scenarios of multiple interdependent medications, adaptation with patients’ condition and behavior, and composite interventions.

Reminders for medication adherence in Type 2 diabetes management apps

AbstractMedication adherence is important for glycaemic control. However, less than half of those with Type 2 diabetes take medications as prescribed. One of the known barriers to medication adherence is forgetfulness. Given the current ubiquity of smartphones, diabetes self‐management apps represent a valuable avenue for providing medication reminders to help users adhere to their medication treatments and improve health outcomes. We assessed 181 diabetes management apps for the presence of medication reminder features and compared their characteristics with the evidence provided in studies showing the effectiveness of SMS reminders. We found that only 55.8% of the apps had a basic medication reminder function, although those that had them conformed to the characteristics of SMS reminders shown to be effective. This is an important missed opportunity for diabetes management apps to contribute not only to improving medication adherence, but also in having a positive effect on the health outcomes of this population.

Medication adherence: A method for designing context-aware reminders

ObjectivesSeveral interventions have been proposed to improve medication adherence including those using reminders. Context-aware reminders can be effective because they operate when the dose is due, has not been taken, and is still safe to take. Although very promising, we find that there is no method to design context-aware reminders. To address these, we focus on proposing a method to design context-aware reminders. MethodsWe conducted a systematic review of context-aware reminders for medication adherence using PRISMA approach. The analysis of literature leads to several interesting observations including the need for a method to design context-aware reminders. In this study, we present Method to Design Context-Aware Reminders (MDCAR) that can also meet special requirements. We used domain experts reasoning to evaluate the designed Context-Aware Reminders for Medication Adherence (CARS-MA). Further, we used analytical model to evaluate reliability, side effects, and cost of intervention. ResultsThis is the first paper that addresses “how to” design context-aware reminders. The proposed design method can lead to range of context-aware reminders including CARS-MA. The verification, validation, and evaluation of CARS-MA indicate that the context-aware reminders perform better than simple reminders in improving medication adherence. ConclusionsThe proposed method for context-aware reminders will help healthcare professionals and researchers to implement and select a suitable intervention to improve medication adherence. Further, it can lead to decision support systems for patients, healthcare professionals, researchers and policy makers for medication adherence. The design method can be extended for complex scenarios of multiple medications, persistent-reminders, and composite interventions.

Support Network Factors Associated With Naming a Health Care Decision-Maker and Talking About Advance Care Planning Among People Living With HIV

ContextLittle attention has been given to social environmental factors associated with advance care planning (ACP) among African Americans or people living with advanced HIV (PLHIV). ObjectivesThe present study aimed to identify support network factors that affect the likelihood of naming a decision-maker and of talking to family/friends and doctors about ACP among vulnerable PLHIV. MethodsPLHIV were recruited from a large urban HIV clinic. A social support network inventory was used to calculate number of persons available for various types of support. Characteristics of network members were also collected. Multivariable logistic regression models were fit to examine associations between social network factors and ACP discussion, adjusting for age, sex, education, and total number of network members. ResultsThe sample (N = 370) was mostly African American (95%), male (56%), and 48% had less than a high school education. Almost half the sample (48%) had talked to their family/friends or doctor about ACP, and 34% had named a medical decision-maker. Adjusted analysis revealed that talking about ACP with family/friends was associated with female sex and a larger closer support network who provided health information and physical assistance. Talking to doctors about ACP was associated with larger support networks who provided physical assistance but lower numbers from whom emotional support was received. Naming a decision-maker was associated with greater numbers of network members who provided emotional support, health information, and medication adherence reminders. ConclusionThe findings revealed aspects of family/support network structures and caregiving function associated with ACP in a population with often vital yet vulnerable networks.

Attitudes, Beliefs, and Willingness Toward the Use of mHealth Tools for Medication Adherence in the Florida mHealth Adherence Project for People Living With HIV (FL-mAPP): Pilot Questionnaire Study.

BackgroundAntiretroviral (ART) adherence among people living with HIV (PLWH) continues to be a challenge despite advances in HIV prevention and treatment. Mobile health (mHealth) interventions are increasingly deployed as tools for ART adherence. However, little is known about the uptake and attitudes toward commercially available, biprogrammatic mobile apps (ie, designed for both smartphone and short message service [SMS] messaging) among demographically diverse PLWH.ObjectivesThe Florida mHealth Adherence Project for PLWH (FL-mAPP) is an innovative pilot study that aimed to determine the acceptability of a commercially available, biprogrammatic mHealth intervention platform to ensure medication adherence and gauge the current attitudes of PLWH toward current and future mHealth apps.MethodsA predeveloped, commercially available, biprogrammatic mHealth platform (Care4Today Mobile Health Manager, Johnson & Johnson, New Brunswick, NJ) was deployed, with self-reported ART adherence recorded in the app and paper survey at both short term (30-day) or long-term (90-day) follow-ups. Consented participants completed baseline surveys on sociodemographics and attitudes, beliefs, and willingness toward the use of mHealth interventions for HIV care using a 5-point Likert scale. Chi-square tests and multivariate logistic regression analyses identified correlations with successful uptake of the mHealth platform.ResultsAmong 132 PLWH, 66% (n=87) initially agreed to use the mHealth platform, of which 54% (n=47) successfully connected to the platform. Of the 87 agreeing to use the mHealth platform, we found an approximate 2:1 ratio of persons agreeing to try the smartphone app (n=59) versus the SMS text messages (n=28). Factors correlating with mHealth uptake were above high school level education (adjusted odds ratio 2.65; P=.05), confidence that a clinical staff member would assist with mHealth app use (adjusted odds ratio 2.92, P=.048), belief that PLWH would use such an mHealth app (adjusted odds ratio 2.89; P=.02), and ownership of a smartphone in contrast to a “flip-phone” model (adjusted odds ratio 2.80; P=.05). Of the sample, 70.2% (n=92) reported daily interest in receiving medication adherence reminders via an app (80.4% users versus 64.7% nonusers), although not significantly different among the user groups (P=.06). In addition, 34.8% (n=16) of mHealth users reported a theoretical “daily” interest and 68.2% (n=58) of non-mHealth users reported no interest in using an mHealth app for potentially tracking alcohol or drug intake (P=.002).ConclusionsThis commercially available, biprogrammatic mHealth platform showed feasibility and efficacy for enhanced ART and medication adherence within public health clinics and successfully included older age groups. Successful use of the platform among demographically diverse PLWH is important for HIV implementation science and promising for uptake on a larger scale.

Reminders for medication adherence: a review and research agenda

Reminders for medication adherence: a review and research agenda

Reminders for medication adherence: a review and research agenda

Reminders are very promising interventions for improving medication adherence as shown in numerous studies. However, there are several challenges including different effectiveness for patients, duration, diseases and complexity of regimen. In this paper, we conduct a systematic review of published literature using multiple databases to address above challenges. The systematic review resulted in identifying 77 papers. After classifying and analysing individual papers, we find that: 1) reminders are effective when patients are busy or have cognitive impairment; 2) there is short-term improvement in MA with reminders; 3) patients lose interest in reminders with time, especially if the message is static or monotonous; 4) medication adherence will not improve if reminders do not address the underlying reasons behind low adherence; and 5) reminders are more suitable for unintentional non-adherence than intentional non-adherence. More research can be done to study and evaluate the effectiveness of reminders over long-term, especially using personalisation and context-awareness. The findings can serve as a resource for healthcare professionals and researchers in deciding when and where to use reminders, for how long and how to improve the effectiveness of reminders.

Task-shifting for cardiovascular risk factor management: lessons from the Global Alliance for Chronic Diseases

Task-shifting to non-physician health workers (NPHWs) has been an effective model for managing infectious diseases and improving maternal and child health. There is inadequate evidence to show the effectiveness of...

Therapeutic effects of mobile-based text message reminders for medication adherence in bipolar I disorder: Are they maintained after intervention cessation?

Mobile phone short messaging service (SMS) reminders may be a low-cost method for promoting medication adherence. Our objective was to determine whether text SMS reminders improve medication adherence in patients with bipolar I disorder even after discontinuation of the intervention. Participants were stable adult bipolar I disorder outpatients on maintenance medication who were randomized to receive treatment as usual (TAU; n = 70) or TAU plus twice-weekly medication reminders by SMS (n = 62) for 3 months. Rater-blinded assessments of medication adherence, treatment attitudes, and quality of life (QoL) were obtained at baseline, at the 3-month intervention endpoint, and at a 3-month post-intervention follow up during which both groups received TAU. Intent-to-treat analyses were conducted on the full randomized sample. The clinical trial protocol was registered with the Clinical Trials Registry of India (CTRI) (CTRI/2016/07/007101). The SMS intervention improved medication adherence and attitudes towards medication at the end of the treatment phase; these benefits were maintained for medication adherence but not for attitudes towards medication at the end of the follow-up phase. The SMS intervention did not improve QoL outcomes. These findings indicate that biweekly SMS reminders improve medication adherence and the benefits persist for at least 3 months after the SMS reminders are discontinued. The SMS reminders do not affect attitudes towards treatment or QoL.

Effectiveness of Medication Adherence Reminders Tied to “Fresh Start” Dates

Low medication adherence is problematic.1 Well-designed reminders can increase adherence,2 but when should reminders be sent to maximize impact? Prior observational studies3 and laboratory experiments4 have shown that engagement in healthy activities increases considerably following “fresh-start” dates—life and calendar events signaling the beginning of new cycles (e.g. birthdays or New Year’s).3,4 Extending this insight, we conducted the first randomized controlled trial (RCT) examining whether sending medication adherence reminders around fresh-start dates and highlighting these dates as an opportunity for positive changes could boost reminders’ effectiveness.

Identifying preferences for mobile health applications for self-monitoring and self-management: Focus group findings from HIV-positive persons and young mothers

ObjectiveSelf-management of risk behaviors is a cornerstone of future population health interventions. Using mobile phones for routine self-monitoring and feedback is a cost-efficient strategy for self-management and ecological momentary interventions (EMI). However, mobile health applications need to be designed to be highly attractive and acceptable to a broad range of user groups. To inform the design of an adaptable mobile health application we aimed to identify the dimensions and range of user preferences for application features by different user groups. MethodsFive focus group interviews were conducted: two (n=9; n=20) with people living with HIV (PLH) and three with young mothers (n=6; n=8; n=10). Thematic analyses were conducted on the focus group sessions’ notes and transcripts. ResultsBoth groups considered customization of reminders and prompts as necessary, and goal setting, motivational messaging, problem solving, and feedback as attractive. For PLH, automated and location-based reminders for medication adherence and sharing data with healthcare providers were both acceptable and attractive features. Privacy protection and invasiveness were the primary concerns, particularly around location tracking, illegal drug use, and sexual partner information. Concerns were ameliorated by use scenario or purpose, monetary incentives, and password protection. Privacy was not a major concern to mothers who considered passwords burdensome. Mothers’ preferences focused on customization that supports mood, exercise and eating patterns, and especially using the mobile phone camera to photograph food to increase self-accountability. ConclusionsIndividualization emerged as the key feature and design principle to reduce user burden and increase attractiveness and acceptability. Mobile phone EMI uniquely enables individualization, context-aware and real-time feedback, and tailored intervention delivery.

Medication adherence: emerging use of technology

Adherence to proven, effective medications remains low, resulting in high rates of clinical complications, hospital readmissions, and death. The use of technology to identify patients at risk and to target interventions for poor adherence has increased. This review focuses on research that tests these emerging technologies and evaluates the effect of technology-based adherence interventions on cardiovascular outcomes. Recent studies have evaluated technology-based interventions to improve medication adherence by using pharmaceutical databases, tailoring educational information to individual patient needs, delivering technology-driven reminders to patients and providers, and integrating in-person interventions with electronic alerts. Cellular phone reminders and in-home electronic technology used to communicate reminder messages have shown mixed results. Only one study has shown improvement in both adherence and clinical outcome. Current trials suggest that increasing automated reminders will complement but not replace the benefits seen with in-person communication for medication taking. Integration of in-person contacts with technology-driven medication adherence reminders, electronic medication reconciliation, and pharmaceutical databases may improve medication adherence and have a positive effect on cardiovascular clinical outcomes. Opportunities for providers to monitor the quality of care based on new adherence research are evolving and may be useful as standards for quality improvement emerge.