Cross-platform remote monitoring technologies to monitor and improve adherence to

跨平台远程监控技术，用于监控和提高遵守情况

• 批准号: 8112892
• 负责人: Barbara Ann Rapchak
• 金额: $ 14.33万
• 依托单位: LEAP OF FAITH TECHNOLOGIES, INC.
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-26 至 2012-09-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8112892
• 关键词: Academia; Activities of Daily Living; Adherence; Admission activity; Adoption; Adverse effects; Affect; Age; Aging; American; Americas; Apple; Back; Businesses; Cancer Center; Cancer Patient; Caring; Cellular Phone; Cessation of life; Chronic Disease; Clinical; Clinical Trials; Collaborations; Communication; Computer software; Data; Data Aggregation; Data Display; Devices; Disease; Disease Progression; Dose; Elderly; Event; Expenditure; Focus Groups; Fortune; Fostering; Frequencies; Health Status; Healthcare; Healthcare Industry; Healthcare Systems; Hospitalization; Hospitals; Industry; Informatics; Internet; Journal of the National Cancer Institute; Letters; Life Style; Marketing; Medicine; Monitor; National Institute on Aging; North Carolina; Nursing Research; Oral; Outcome; Patient Care; Patient Outcomes Assessments; Patients; Pharmaceutical Preparations; Pharmacologic Substance; Pharmacy facility; Phase; Philadelphia; Physicians; Pilot Projects; Provider; Publishing; Quality of life; Radio; Randomized Controlled Trials; Relative (related person); Reporting; Research; Robert H Lurie Comprehensive Cancer Center of Northwestern University; Running; Sampling; Schedule; Science; Self Efficacy; Small Business Innovation Research Grant; Solutions; Staging; Symptoms; System; Technology; Testing; Therapeutic; Therapeutic Index; Time; Touch sensation; Toxic effect; United States; Universities; Visit; Wireless Technology; Work; base; behavioral health; clinically significant; college; commercialization; cost; demographics; design; improved; medical supply; medication compliance; preference; prevent; prototype; research and development; success; usability; web interface; web services

DESCRIPTION (provided by applicant): Medication nonadherence is a costly healthcare problem, adding $177 billion annually to the nation's healthcare expenditures. Three out of four Americans do not take their medicine as prescribed, and the ramifications affect virtually every aspect of the health care system. It is called America's other drug problem for good reason. Nonadherence issues are particularly troublesome with oral chemotherapeutic medications, which are increasingly entering the market, and which often have severe toxicities and narrow therapeutic indices. A review of adherence published in the Journal of the National Cancer Institute found that up to 80 percent of cancer patients failed to follow their prescriptions. There is not a "one size fits all" solution to the adherence problem. Thus, this Fast Track application aims to facilitate widespread adoption of promising telemonitoring technology for improving medication adherence by extending it to additional wireless platforms to make it accessible to broad sociodemographic groups. It fosters partnerships among collaborators from academia, healthcare, and industry working together toward this aim. The proposed RandD would enable us to make very promising technology available to more people who could benefit from it by acknowledging their age, lifestyle, disease state, and preference for a particular communication strategy and platform. The existing technology was developed through a Small Business Innovation Research (SBIR) grant from the National Institute on Aging. It integrates cell phones, radio frequency identification (RFID), and health and behavioral informatics to optimize medication compliance, track medication use, and extend patient care to the ambulatory setting. It has consistently demonstrated adherence rates of 96 percent to 98 percent, along with clinically significant improvements in self efficacy, in randomized control studies among elderly chronic disease and cancer patients taking from 1 to 11 medications/day. Usability testing was conducted by an independent third party at NCI's User-Centered Informatics Research Lab with outstanding success. Patients reported that the technology makes them feel more confident that they will be able to manage their medications. Clinicians participating in the usability testing gave the clinical interface and Web service high marks, calling it "a great boon for the research nurse or clinical trial coordinator." We will extend the existing telemonitoring technology, which runs on a cellphone/PDA, to three new platforms: a low-cost smartphone, the Apple iPhone, and an Internet appliance called Chumby. Work will proceed through six stages. In Phase I we will: (1) develop functional prototypes on three new platforms (2) conduct focus groups to evaluate acceptance by patient end-users, and end-user demographics relative to preference for a particular platform. In Phase II we will: (3) develop full functionality on three new platforms based on focus group input (4) integrate and aggregate adherence and patient reported outcomes data from all platforms through a single web service and user interface (5) conduct a pilot study to demonstrate technical feasibility and assess usability and efficacy (6) assess acceptance of the web service and clinical interface among a sample of clinicians, physicians, providers, and stakeholders in the pharmaceutical supply chain. PUBLIC HEALTH RELEVANCE: This Fast Track application aims to facilitate widespread adoption of promising telemonitoring technology for improving medication adherence by extending it to additional wireless platforms to make it accessible to broad sociodemographic groups. Three out of four Americans do not take their medicine as prescribed, and the ramifications affect virtually every aspect of the health care system. Lack of medication compliance leads to unnecessary disease progression and complications, additional doctor visits and hospitalizations, reduced functional abilities, early admission to assisted-care facilities, lower quality of life, and even death. It is called America's other drug problem for good reason. The current telemonitoring technology has consistently demonstrated adherence rates of 96 percent to 98 percent in randomized control studies among elderly chronic disease and cancer patients taking from 1 to 11 medications/day. There is not a "one size fits all" solution to the adherence problem. The proposed RandD would enable us to make very promising technology available to more people who could benefit from it by acknowledging their age, lifestyle, and preference for a particular communication strategy and platform. Telemonitoring such as that proposed here may facilitate patient self-efficacy and improve adherence to recommended dosing to optimize outcomes and enable "aging in place." It fosters partnerships among collaborators from academia, healthcare, and industry working together toward this aim.

描述（由申请人提供）：药物依从性是一个昂贵的医疗保健问题，每年增加1770亿美元的国家医疗保健支出。四分之三的美国人不按处方服药，其后果几乎影响到医疗保健系统的各个方面。它被称为美国的另一个毒品问题是有充分理由的。口服化疗药物的不依从性问题尤其棘手，这类药物越来越多地进入市场，而且往往具有严重的毒性和狭窄的治疗指标。发表在《国家癌症研究所杂志》（Journal of the National Cancer Institute）上的一篇关于药物依从性的综述发现，高达80%的癌症患者未能遵医嘱用药。对于坚持服药的问题，没有“一刀切”的解决方案。因此，这一快速通道应用程序旨在促进广泛采用有前途的远程监测技术，通过将其扩展到其他无线平台，使其能够为广泛的社会人口群体所使用，从而提高药物依从性。它促进了来自学术界、医疗保健和行业的合作者之间的伙伴关系，共同努力实现这一目标。拟议的RandD将使我们能够将非常有前途的技术提供给更多的人，通过承认他们的年龄、生活方式、疾病状态以及对特定通信策略和平台的偏好，他们可以从中受益。现有的技术是通过国家老龄化研究所的小企业创新研究（SBIR）资助开发的。它集成了手机、射频识别（RFID）以及健康和行为信息学，以优化药物依从性，跟踪药物使用，并将患者护理扩展到门诊环境。在老年慢性疾病和癌症患者每天服用1至11种药物的随机对照研究中，它一直显示出96%至98%的依从率，以及临床显着的自我效能改善。可用性测试由NCI的以用户为中心的信息学研究实验室的独立第三方进行，取得了显著的成功。患者报告说，这项技术使他们对自己能够管理药物更有信心。参与可用性测试的临床医生给临床界面和Web服务打了高分，称其为“研究护士或临床试验协调员的一大福音”。我们将把现有的在手机/PDA上运行的远程监控技术扩展到三个新平台：低成本智能手机、苹果iPhone和名为Chumby的互联网设备。工作将分六个阶段进行。在第一阶段，我们将：(1)在三个新平台上开发功能原型；(2)进行焦点小组讨论，以评估患者最终用户的接受程度，以及最终用户人口统计数据对特定平台的偏好。在第二阶段，我们将：(3)基于焦点小组的输入，在三个新平台上开发完整的功能；(4)通过单一的网络服务和用户界面，整合和汇总来自所有平台的依从性和患者报告的结果数据；(5)进行试点研究，以证明技术可行性并评估可用性和有效性；(6)评估临床医生、医生、提供者和药品供应链中的利益相关者样本对网络服务和临床界面的接受程度。