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Prescription Adherence

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jacob jordan

on 25 July 2016

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Transcript of Prescription Adherence

Medication Adherence and
Text Message Reminders

Medication Adherence Overview
Define Medication Adherence
Extent and Causes of Problems
HIT Solution: Text Messaging
External Factors
Conclusion
Text Message
Reminders

Conclusion
External Factors
Medication Adherence
Causes of Nonadherence
Review
References
Tina Johnson, Whitney Hayward, Arriel Garris, Jacob Jordan
Background
Problems
20 - 30% of prescriptions never filled
50% not continued as prescribed
Rates of adherence drop after first 6-months
Estimated annual direct cost between $100 and 289 billion
$2000 per patient in physcian visits yearly
30 - 50% of treatment failures
125,000 deaths annually
Increased emergency room visits
Definition: "The patient’s conformance with the provider’s recommendation with respect to timing, dosage, and frequency of medication-taking during the prescribed length of time"
By 2020, 157 million Americans with at least one chronic condition will require medication therapy
Non-adherence
Not filling prescription
Taking more or less
Ending prescription early
Intentional
Active decision to not take medication
Rational and influenced by patient beliefs
Unintentional
Passive, unplanned behavior
Forgetful
Confused by directions
How Is Text Messaging Used?
Simple reminder to take medication
Several applications offer this service
Requirements:
Cellular communication infrastructure
Patient use of cell phone
Securely transmit PPI
Goal:
Improve adherence to medication
Improve patient condition
Does It Help?
Measure Success
Self-reported adherence in interviews
INTERACT Trial
Reduced non-adherence by more than half
Reminded 65% on at least one occasion
JAMA Meta-Analysis
Doubles the odd of adherence
More studies needed
How Do People Feel?
Cell Phones
Regulatory Compliance
MED experiment to engage patients with phones
80% responded to text inquiries
Most responsive age group: 25 - 50 year-olds
Those over 50 respond less than middle-aged
Concerns
HIPPA security
Cultural differences: non-white respond less
Elderly and poor harder to engage
326 million wireless subscribers
2.2 trillion text messages
Medical Texting Services
CareSpeak Communications' Mobile Medication Manager
"Continuous, interactive communication"
Miscommunication: no auditory/visual cues
Misinterpretation
Health Insurance Portability and Accountability Act of 1996 (HIPPA)
Publicize standards for the electronic exchange, privacy and security of health information
Healtchare organizations must:
Maintain reasonable safeguards
Develop and implement written privacy policies
Train members in privacy
Create and use sanctions against members who violate privacy
Conduct periodic safety audits and risks assessments
HITECH and ACA

Health Information Technology for Economic and Clinical Health
Establish programs to improve health care quality, safety, and efficiency through the promotion of health IT
Affordable Care Act
Provisions to encourage proper medication use
Pay-for-performance systems
financial incentives for achieving better outcomes
Risks
Security Risks:
Theft/Loss
Improper disposal
Unauthorized interception of ePHI transmission
Lack of availability of ePHI to other persons
Miscommunication
No auditory/visual cues
Misinterpretation of messages
Unreliable service
Radio waves travel between cell bases
Proximity, physical obstacles, weather, interference
American College of Healthcare Executives Online. Health Information Confidentiality. Retrieved from http://www.ache.org/policy/hiconf.cfm
Can Cell Phone Patient Engagement Reduce Medication Non-Adherence? (2016). Retrieved July 21, 2016, from http://patientengagementhit.com/news/can-cell-phone-patient-engagement-reduce-medication-non-adherence
Center for Disease Control (2013). Medication Adherence. Retrieved from https://www.cdc.gov/primarycare/materials/medication/docs/medication-adherence-01ccd.pdf
Federal Communications Commission Online. Understanding wireless telephone coverage areas. Retrieved from https://www.fcc.gov/consumers/guides/understanding-wireless-telephone- coverage-areas
Greene, Adam H. (2012). HIPAA compliance for clinician texting. Journal of AHIMA 83(4), 34-36. Retrieved from http://library.ahima.org/doc?oid=105342#.V5HtehFf2Uk
Grossman, E. G, Sterkx, C. A., Blount, E. C. and Volberding, E. M. (2010). Compilation of patient protection and affordable care act.. Retrieved from http://housedocs.house.gov/ energycommerce/ppacacon.pdf
Ha, J. F., & Longnecker, N. (2010). Doctor-patient communication: a review. The Ochsner Journal, 10(1), 38–43. Retrieved from http://ochsnerjournal.org/doi/abs/10.1043/TOJ-09- 0040.1
Hamilton, G., Byatt, G, and Hodgkinson, J. (2010). Communication risks within and around a virtual team. Retrieved from http://www.cio.com.au/article/370285/communication_risks_within_around_virtual_team/
Hugtenburg, J. G., Timmers, L., Elders, P. J., Vervloet, M., & van Dijk, L. (2013). Definitions, variants, and causes of nonadherence with medication: a challenge for tailored interventions. Patient Preference and Adherence, 7, 675–682. http://doi.org/10.2147/PPA.S29549
References continued
James, J. (2012). Health policy briefs. Health Affairs. Retrieved from http://www.healthaffairs.org/ healthpolicybriefs/brief.php?brief_id=78
Mears, T. (2015, November 16). 10 Essential Tech Tools for Older Adults. Retrieved July 24, 2016, from http://money.usnews.com/money/retirement/articles/2015/11/16/10-essential-tech-tools-for-older-adults
MedTexter (2014). MedTexter Medication Adherence App and Medication Reminders. Retrieved from https://www.youtube.com/watch?v=mzRZq13zY3
Thakkar, J., Kurup, R., Laba, T., et al. (2016). Mobile Telephone Text Messaging for Medication Adherence in Chronic Disease: A Meta-analysis. JAMA Intern Med. 176(3):340-349. doi:10.1001/jamainternmed.2015.7667.
Torgan, Carol. (2013). Patient outcomes improved by pay-for-performance. NIH Research Matters. Retrieved from https://www.nih.gov/news-events/nih-research-matters/patient-outcomes-improved-pay-performance
U.S. Department of Health and Human Services. (2014). Health Resources and Services Administration. Using health text messages to improve consumer health knowledge, behaviors, and outcomes: an environmental scan. Retrieved from http://www.hrsa.gov/healthit/txt4tots/environmentalscan.pdf
Wald, D. S., Bestwick, J. P., Raiman, L., Brendell, R., and Wald, N. J. (2014). Randomised Trial of Text Messaging on Adherence to Cardiovascular Preventive Treatment (INTERACT Trial). PLoS ONE 9(12): e114268. doi:10.1371/journal.pone.0114268James, J. (2012). Health policy briefs. Health Affairs. Retrieved from http://www.healthaffairs.org/ healthpolicybriefs/brief.php?brief_id=78
Text message reminders attempt to reduce unintentional nonadherence
Studies support effectiveness of reminders
Presence of security, miscommunication, and unreliability risks
125,000 deaths caused by nonadherence
Reduce half by text messages (62,000)
Elderly becoming more proficient with technology
Requires continued support by providers and patients
Full transcript