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

描述(由申请人提供)：用药不坚持是一个代价高昂的医疗问题，每年增加1770亿美元的国家医疗支出。四分之三的美国人没有按照处方服药，其后果几乎影响到医疗保健体系的方方面面。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数，不依从性问题尤其令人头疼。发表在国家癌症研究所杂志上的一篇关于依从性的综述发现，高达80%的癌症患者没有遵循他们的处方。对于遵守问题，没有“一刀切”的解决方案。因此，这一Fast Track应用程序旨在通过将其扩展到更多的无线平台，使其能够被更广泛的社会人口统计群体访问，从而促进广泛采用有前景的远程监测技术，以改善药物依从性。它促进了学术界、医疗保健和行业的合作者之间的合作伙伴关系，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、疾病状况以及对特定通信策略和平台的偏好而从中受益。现有技术是通过国家老龄研究所的小企业创新研究(SBIR)赠款开发的。它集成了手机、射频识别(RFID)以及健康和行为信息学，以优化用药依从性、跟踪用药情况并将患者护理扩展到门诊环境。在对每天服用1至11种药物的老年慢性病和癌症患者进行的随机对照研究中，它一直显示出96%至98%的依从率，同时自我效能在临床上也有显著改善。可用性测试由独立的第三方在NCI以用户为中心的信息学研究实验室进行，取得了显著的成功。患者报告说，这项技术让他们更有信心能够管理自己的药物。参与可用性测试的临床医生给临床界面和Web服务打了很高的分，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，以评估患者最终用户的接受度，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结果数据(5)进行试点研究，以论证技术可行性并评估可用性和有效性(6)评估药品供应链中临床医生、医生、提供者和利益相关者对网络服务和临床界面的接受程度。

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.