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

描述（由申请人提供）：药物不依从性是一个昂贵的医疗保健问题，每年增加1770亿美元的国家的医疗保健支出。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令人烦恼，口服化疗药物越来越多地进入市场，并且通常具有严重的毒性和狭窄的治疗指数。发表在《国家癌症研究所杂志》上的一项关于依从性的评论发现，高达80%的癌症患者没有遵循他们的处方。没有一个“一刀切”的解决方案的坚持问题。因此，该快速通道应用程序旨在通过将其扩展到其他无线平台，使其可用于广泛的社会人口群体，从而促进广泛采用有前途的远程监护技术，以提高药物依从性。它促进了来自学术界，医疗保健和工业界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将使我们能够向更多的人提供非常有前途的技术，这些人可以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而从中受益。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），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。在老年慢性病和癌症患者中进行的随机对照研究中，每天服用1至11种药物的依从率一直在96%至98%之间，沿着自我效能的临床显著改善。可用性测试由独立的第三方在NCI的以用户为中心的信息学研究实验室进行，并取得了巨大的成功。患者报告说，这项技术使他们对管理药物更加有信心。参与可用性测试的临床医生对临床接口和Web服务给予了很高的评价，称其为“对研究护士或临床试验协调员来说是一个巨大的布恩。“我们将把现有的远程监护技术（运行在手机/PDA上）扩展到三个新的平台：一个低成本的智能手机、苹果iPhone和一个名为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，以及与特定平台偏好相关的最终用户人口统计数据。在第二阶段，我们将：（3）根据焦点小组的意见，在三个新平台上开发全部功能（4）通过单一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、内科医生、提供者以及医药供应链中的利益相关者。 公共卫生相关性：此快速通道应用程序旨在促进广泛采用有前途的远程监护技术，通过将其扩展到其他无线平台，使其可用于广泛的社会人口群体，从而提高药物依从性。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。缺乏药物依从性会导致不必要的疾病进展和并发症，额外的医生就诊和住院，功能降低，早期进入辅助护理设施，生活质量降低，甚至死亡。它被称为美国的另一个毒品问题是有充分理由的。目前的远程监护技术在老年慢性病和癌症患者的随机对照研究中一直显示出96%至98%的依从率，每天服用1至11种药物。没有一个“一刀切”的解决方案的坚持问题。拟议中的RandD将使我们能够向更多的人提供非常有前途的技术，这些人可以通过承认他们的年龄，生活方式以及对特定通信策略和平台的偏好而从中受益。远程监护，如这里提出的，可以促进患者的自我效能和改善遵守推荐的剂量，以优化结果，并使“老化的地方。“它促进了来自学术界、医疗保健和工业界的合作者之间的伙伴关系，共同努力实现这一目标。

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.