Digital Pills to Measure Opioid Ingestion Patterns in Emergency Department Patients With Acute Fracture Pain: A Pilot Study
Digital Pills to Measure Opioid Ingestion Patterns in Emergency Department Patients With Acute Fracture Pain: A Pilot Study
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DOI：
10.2196/jmir.7050
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发表时间：
2017-01-01
影响因子：
7.4
通讯作者：
Boyer, Edward W.
中科院分区：
文献类型：
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作者：
Chai, Peter R.;Carreiro, Stephanie;Boyer, Edward W.
背景：不遵守阿片类镇痛药的处方方案有助于增加阿片类药物滥用和过量死亡。阿片类药物经常根据需要开处方，由患者负责确定阿片类药物的剂量和频率。由于缺乏描述患者如何实际使用按需阿片类镇痛药的数据，医生处方模式存在很大差异。数字药丸系统有一个射频发射器，直接测量药物摄入事件，他们提供了一个机会，发现剂量，时间和阿片类药物therapeutic.Objective：本研究的目的是确定一种新的数字药丸系统的可行性，以测量急性骨折后从急诊科（艾德）出院的患者按需阿片类药物摄入模式。我们使用数字药丸与个人谁提出了一个教学医院艾德急性四肢骨折。数字药丸包括一个数字射频发射器在一个标准的明胶胶囊，封装羟考酮片剂。当摄入时，胃中的氯离子梯度激活数字药丸，发射射频信号，由臀部佩戴的接收器接收，然后将摄入数据传输到基于云的服务器。在艾德进行了简短的实践培训后，研究参与者出院回家，并使用数字药丸系统摄入根据疼痛需要开具的羟考酮一周。我们进行了药丸计数，以验证数字药丸数据，并在参与者与骨科的随访预约时或参加研究后一周内与参与者进行开放式访谈，以确定有关数字药丸的知识，态度，信念和实践。我们分析了开放式访谈，采用应用主题analysis.Results：我们招募了10名研究参与者，并记录了96摄入事件（87.3%，96/110的准确率）。研究参与者报告说，在培训后，他们能够操作数字药丸系统的各个方面。两名参与者停止使用数字药丸，报告说他们太痛苦了，无法专注于这项新技术。数字药丸系统检测到数字药丸系统的多个同时摄入事件。参与者在研究期间平均摄入8粒（SD 5）数字药丸，4名参与者在研究结束时继续服用阿片类药物。在与真实的世界中的数字药丸系统进行交互后，参与者发现该系统非常可接受（80%，8/10），并报告愿意继续使用数字药丸，以改善药物依从性监测（90%，9/10）。结论：数字药丸是一种可行的方法，可以测量急性疼痛患者的实时阿片类药物摄入模式，并开发真实的如果发现阿片类药物滥用，应及时采取干预措施。部署数字药丸是可能的，通过艾德与短期教学课程。使用数字药丸的患者接受了这项技术。
Background: Nonadherence to prescribed regimens for opioid analgesic agents contributes to increasing opioid abuse and overdose death. Opioids are frequently prescribed on an as-needed basis, placing the responsibility to determine opioid dose and frequency with the patient. There is wide variability in physician prescribing patterns because of the lack of data describing how patients actually use as-needed opioid analgesics. Digital pill systems have a radiofrequency emitter that directly measures medication ingestion events, and they provide an opportunity to discover the dose, timing, and duration of opioid therapy.Objective: The purpose of this study was to determine the feasibility of a novel digital pill system to measure as-needed opioid ingestion patterns in patients discharged from the emergency department (ED) after an acute bony fracture.Methods: We used a digital pill with individuals who presented to a teaching hospital ED with an acute extremity fracture. The digital pill consisted of a digital radiofrequency emitter within a standard gelatin capsule that encapsulated an oxycodone tablet. When ingested, the gastric chloride ion gradient activated the digital pill, transmitting a radiofrequency signal that was received by a hip-worn receiver, which then transmitted the ingestion data to a cloud-based server. After a brief, hands-on training session in the ED, study participants were discharged home and used the digital pill system to ingest oxycodone prescribed as needed for pain for one week. We conducted pill counts to verify digital pill data and open-ended interviews with participants at their follow-up appointment with orthopedics or at one week after enrollment in the study to determine the knowledge, attitudes, beliefs, and practices regarding digital pills. We analyzed open-ended interviews using applied thematic analysis.Results: We recruited 10 study participants and recorded 96 ingestion events (87.3%, 96/110 accuracy). Study participants reported being able to operate all aspects of the digital pill system after their training. Two participants stopped using the digital pill, reporting they were in too much pain to focus on the novel technology. The digital pill system detected multiple simultaneous ingestion events by the digital pill system. Participants ingested a mean 8 (SD 5) digital pills during the study period and four participants continued on opioids at the end of the study period. After interacting with the digital pill system in the real world, participants found the system highly acceptable (80%, 8/10) and reported a willingness to continue to use a digital pill to improve medication adherence monitoring (90%, 9/10).Conclusions: The digital pill is a feasible method to measure real-time opioid ingestion patterns in individuals with acute pain and to develop real-time interventions if opioid abuse is detected. Deploying digital pills is possible through the ED with a short instructional course. Patients who used the digital pill accepted the technology.