Medication Management Apps by Kelly Grindrod

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Slide Notes

Medication Management Apps

Published on Nov 21, 2015

To make an impact in healthcare, we need to build and test mHealth tools with the biggest consumers of healthcare. Yet, our ability to adopt technology is influenced by age, income and education. This presentation discusses why older adults are an important mHealth demographic and why we should build to their abilities and needs.

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PRESENTATION OUTLINE

Smart Meds

Medication Management Apps

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Kelly Grindrod

University of Waterloo, School of Pharmacy

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@kgrindrod

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Agenda

Definitions
Pharmacy Informatician
Some apps to look at
Your practice

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Are medication management apps missing the point?

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What is a med management app?

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An electronic tool used on a mobile device to track, understand and/or organize medication therapy.

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Common Features

List making
Dose tracking
Audio reminders
Drug Information
Drug interaction checking
Refill ordering

What good is a med management app?

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10.

That's the big question...

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11.

Canada: Who is using health care dollars?

A minority of Ontarians are using the majority of healthcare dollars. These are our "high impact" users.

Source: Wodchis W et al. The concentration of healthcare spending: little ado (yet) about much money. Presented at CAHSPR 2012 at https://www.longwoods.com/articles/images/The_Concentration_of_Healthcare_S...

12.

US: Who is using health care dollars?

The numbers are similar in the US, with high impact users responsible for almost half of healthcare spending. A key difference may be in the number of uninsured high impact users in the US (vs the universal health system in Ontario).

Source: Stanton & Rutherford. The high concentration of US healthcare expenditures. AHRQ 2006.

13.

Half of people stop taking their cardiac and diabetes meds within a year.

Cramer JA, Benedict A, Muszbek N, Keskinasian A. Khan ZM. The significance of compliance and persistence in the treatment of diabetes, hypertension and dyslipidaemia: a review. Int J Clin Pract 2008; 62(1):76-87. PMID 17983433.
Ho PM, Spertus JA, Masoudi FA, Reid KJ, Peterson ED, Magid DJ, Krumholz HM, Rumsfeld JS. Impact of medication therapy discontinuation on mortality after myocardial infarction. Arch Intern Med 2006; 166(17): 1842-7. PMID 17000940.
Kramer JM, Hammill B, Anstrom KJ, Fetterolf D, Snyder R, Charde JP, Hoffman BS, Allen LaPointe N, Peterson E.National evaluation of adherence to beta-blocker therapy for 1 year after acute myocardial infarction in patients with commercial health insurance. Am Heart J 2006; 152(3):454.e1-8. PMID 16923412.

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14.

Half of people stop taking meds for mental illness within 3 months.

Chong WW, Aslani P, Chen TF. Effectiveness of interventions to improve antidepressant medication adherence: a systematic review. Int J Clin Pract. 2011 Sep;65(9):954-75. PMID 21849010.

Arvilommi P, Suominen K, Mantere O, Leppämäki S, Valtonen H, Isometsä E. Predictors of adherence to psychopharmacological and psychosocial treatment in bipolar I or II disorders - an 18-month prospective study. J Affect Disord 2013: Epub ahead of print. doi: 10.1016/j.jad.2013.10.032. PMID 24262639.

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15.

People who need help tend to be low income, older, less educated, and/or mentally ill.

In Canada, 10% of the population is non-adherent for cost reasons. For vulnerable Canadians who are homeless or who have unstable housing, the most common reasons for non-adherence include side effects and lack of access to a physician, in addition to cost. Further, adherence is higher in younger individuals and those with harmful drinking patterns.

World Health Organization. Adherence to long-term therapies. 2003. http://www.who.int/chp/knowledge/publications/adherence_report/en/

Hunter CE, Palepu A, Farrell S, Gogosis E, O'Brien K, Hwang SW. Barriers to Prescription Medication Adherence Among Homeless and Vulnerably Housed Adults in Three Canadian Cities. J Prim Care Community Health. 2014(Nov 26): Epub.

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Untitled Slide

The five dimensions of adherence include the following: 1) social and economic factors such as income, literacy and education; 2) therapy factors such as treatment duration, regimen complexity and previous treatment failure; 3) patient factors such as self-efficacy and forgetfulness; 4) condition factors such as symptoms severity and disability; and 5) health systems factors such as patient provider relationships and overworked healthcare providers.

World Health Organization. Adherence to long-term therapies. 2003. http://www.who.int/chp/knowledge/publications/adherence_report/en/

17.

How do the apps compare?

Dayer L, Heldenbrand S, Anderson P, Gubbins PO, Martin BC. Smartphone medication adherence apps: potential benefits to patients and providers. J Am Pharm Assoc (2003). 2013 Mar-Apr;53(2):172-81. doi: 10.1331/JAPhA.2013.12202.

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18.

Of 140+ med management apps...

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...most provide lists and reminders.

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Here are some of the features...

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Also, when we looked at 39 free med management apps on Canadian iTunes...

22.

Most lacked basic security functions.

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Even though med management apps are the most sensitive app type.

Dehling et al identified 12 different archetypes of mobile health apps. The medication reminder and medication management apps were considered to be the 2 categories that could cause damage if data were manipulated or lost or stolen by third parties.

Dehling T, Gao F, Schneider S, Sunyaev A
Exploring the Far Side of Mobile Health: Information Security and Privacy of Mobile Health Apps on iOS and Android
JMIR mHealth uHealth 2015;3(1):e8

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24.

So, where do med management apps fit in pharmacy practice?

Often patients with multiple conditions, complex care needs and people who "don't feel their best." Pharmacists spend their days with people who don't feel their best.

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Because pharmacists know patients.

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Pharmacists know who needs help.

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There is a need for a Pharmacy Informatician

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There is a need pharmacist designers.

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32.

A quick note on
the digital divide (or island).

We don't all adopt technology in the same way.

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We are isolated by age, income and education.

We are divided by age, income and education.

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Canada Internet Use Survey (2012)

More recent Canadian data shows how our adoption of technology is affected by our sociodemographic characteristics. People in higher income brackets are more likely to have internet access.

Statistics Canada. Table 358-0152 - Canadian Internet use survey, Internet use, by age group and household income for Canada, provinces and census metropolitan areas (CMAs), occasional (percent), CANSIM (database). (accessed: 2014-11-14)

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Canada Internet Use Survey (2012)

People with more education are more likely to have internet access.

Statistics Canada. Table 358-0152 - Canadian Internet use survey, Internet use, by age group and household income for Canada, provinces and census metropolitan areas (CMAs), occasional (percent), CANSIM (database). (accessed: 2014-11-14)

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Canada Internet Use Survey (2012)

In other words, almost 100% of young people who have a high income are online but only 1 in 4 older adults who have a low income are online.

That's the digital divide, or the digital island.

Statistics Canada. Table 358-0152 - Canadian Internet use survey, Internet use, by age group and household income for Canada, provinces and census metropolitan areas (CMAs), occasional (percent), CANSIM (database). (accessed: 2014-11-14)

37.

Handheld Ownership

Similarly, even though older adults are less likely to own a smartphone or tablet, a good one third of people over age 65 do own one. That's a lot of people.

Statistics Canada. Table 358-0152 - Canadian Internet use survey, Internet use, by age group and household income for Canada, provinces and census metropolitan areas (CMAs), occasional (percent), CANSIM (database). (accessed: 2014-11-14)

38.

It's more important to think of who will than who wont.

If we think back to to the first TV remotes. They were simple and served a clear purpose and now everyone who watches television uses one.

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My team studies digital health technologies.

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Study 1:
Medication apps

This is a study we did with older to explore medication management apps. The biggest lesson we learned here was that med management apps were not being designed for people who actually use meds. This was the first time we really understood the disconnect between developers and users.

Grindrod K, Li M, Gates A. Evaluating User Perceptions of Mobile Medication Management Applications With Older Adults: A Usability Study. JMIR mHealth uHealth 2014; 2(1). Jan-Mar. http://mhealth.jmir.org/2014/1/e11/

41.

Study 2: ClereMed

Here's a study where we became the developer and our biggest lesson learned was that it is really difficult to solve a patient's problem by targeting a health professional's behaviour. We designed a tool to help health professionals identify people who could not read or understand labels. When we tested it, no health professionals wanted to use it. By comparison, patients thought it was a great idea. We were disconnected from our users. We designed for the patient and ignored the health professional user.

Grindrod KA, Gates A, Dolovich L, Slavcev R, Drimmie R, Aghaei B, Poon C, Khan S, Leat SJ
ClereMed: Lessons Learned From a Pilot Study of a Mobile Screening Tool to Identify and Support Adults Who Have Difficulty With Medication Labels
JMIR mHealth uHealth 2014;2(3):e35 http://mhealth.jmir.org/2014/3/e35/

42.

Study 3: Activity Trackers

In our most recent study, which was presented as a poster at Med 2.0, we asked older adults to try out some new activity trackers. Our big lesson learned here was that the challenge was not in getting someone to adopt a fancy new or emerging technology. It was getting them to adopt something designed, advertised and positioned for younger users.

Unpublished (Nov 2014). See poster from Medicine 2.o (Maui): http://www.slideshare.net/grindrod/wearables-poster-nov-2014. Submitted to JMIR mHealth uHealth in Jan 2015.

43.

Study 4: Audible Rx & Health Literacy

This is a study we are currently working on with Steve Leuck in California. He's created a great website and app with audible podcasts of pharmacist medication counseling. We are working with him to make the podcasts more accessible to people with lower health literacy.

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eHealth Literacy Workshops

We now regularly hold eHealth literacy workshops in our community. This is the "clinical practice site" for my research team. Every week we partner students and seniors up to explore the different ways of searching the Internet for health information.

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Here's what we've learned.

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46.

Some reasons to use a med management app include...

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Having a portable list of medications.

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48.

MyMedRec.

MyMedRec is an app put out by ISMP Canada, Rx&D and endorsed by the CMA and CPhA. It is designed to help patients maintain a list of their medications on their phones. It also has reminder features. It's especially good for someone who wants something simple. However, some patients may want to have a health professional add the information into the app to avoid errors, which can be common with patient-order entry.

49.

Having dose reminders.

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50.

Untitled Slide

Dosecast gives a good example of the typical medication reminder system. Usually there's a feature to mark that you took it, delay the alert or skip a dose.

51.

Getting more information.

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52.

DrugHub

Great-West Life has an app called DrugHub that is a virtual pill cabinet. In addition to the standard reminders, it also has a standard database of medication handouts for patients. The information is similar to what you'd see on a pharmacy information sheet.

53.

Connecting family members.

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54.

Medi-Safe

Medi-Safe is from Isreal. It's focus is on connecting families around medications to boost adherence. They claim the app has much higher adherence rates (80%+) that usual care. This would be a nice option for parents who want to monitor adherence in children.

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