3:20 - 3:40 pmSaturday, September 6
LK 102
Targeting medication non-adherence behavior in immunology: A systematic approach to digital health program development
LK 102
Targeting medication non-adherence behavior in immunology: A systematic approach to digital health program development
Managing Director, Evolution Health
Background29 autoimmune diseases, including Rheumatoid Arthritis, gout, Crohn’s Disease, and Systematic Lupus Erythematosus affect 7.6-9.4% of the population. While effective treatment is available... Read more

Description

Background

29 autoimmune diseases, including Rheumatoid Arthritis, gout, Crohn’s Disease, and Systematic Lupus Erythematosus affect 7.6-9.4% of the population. While effective treatment is available to help manage these conditions, many patients do not use medications effectively, and estimates suggest that medication non-adherence rates vary from 7-84%. Digital health and Web 2.0 interventions have demonstrated much promise in the delivery of interventions that increase medication and treatment adherence, but to date many Internet tools have proven disappointing. In fact, most digital interventions continue to suffer from high attrition in patient populations, are burdensome for healthcare professionals, and have relatively short life spans.

Objective

Over the past decade traditional approaches in digital health development have centered on the adaptation of existing patient strategies to digital format, such as diaries, trackers, stage-based or cognitive behavioral therapy, web-based coupon downloads, or symptom checklists. Advanced digital interventions have also incorporated attributes of Web 2.0 such as social networking, text messaging, and the use of video. Despite these efforts, there has not been a measurable impact in non-adherence for illnesses that require medical interventions, and research must look to other strategies or development methodologies. As a first step in understanding specific needs of patients, the objective of this study was to systematically uncover non-adherence risk factors in the Immunology literature.

Method

Grounded Theory, recognized as a rigorous method that facilitates the emergence of new themes through systematic analysis, data collection and coding, was used to analyze quantitative, qualitative and mixed method Immunology studies. Studies were only included if they contained primary data addressing the relationship between non-adherence and Immunology. To follow best practices in the science of systematic reviews, PRISMA guidelines were followed.

Results

Out of the 27 studies, four non-modifiable and 11 modifiable risk factors were discovered. Over one third of articles identified the following risk factors as common contributors to medication non-adherence (percent of studies reporting) - patients not understanding treatment (44%), side effects (41%), age (37%), dose regimen (33%), and perceived medication ineffectiveness (33%). An unanticipated finding that emerged was the need for risk stratification tools (81%) with patient-centric approaches (67%).

Conclusions 

To our knowledge this is the first study that systematically identifies and categorizes medication non-adherence risk factors in Immunology. Findings indicate that patients understanding of their disease and the role of medication are paramount. An unexpected finding was that the majority of research articles called for the creation of tailored, patient-centric interventions that dispel personal misconceptions about pharmacotherapy, and how the body responds. The literature also calls for these tools to be designed in a participatory format, so patients, their doctors, family members, and other caregivers can access them. While past development methodologies delivered adapted interventions to individuals, future interventions might first focus on the individual, and then through the use of algorithms, tailor a patient-centric intervention. Strengths and limitations are discussed. 

Rachel Fournier is Managing Director of Evolution Health Systems Inc., a company that specializes in evidence-based medication and treatment adherence. She is primarily responsible for fostering long-term client relationships and establishing new partnerships by delivering value-driven digital programs for health systems and pharma. In addition to her business development and corporate growth responsibilities, Rachel is working towards a doctoral degree investigating Return on Investment of adherence programs. A second-generation Silicon Valley geek, Rachel is thrilled to return to the Medicine X conference at Stanford where she earned her Bachelor of Science in the interdisciplinary Program in Science, Technology and Society.

Contact Us

We're not around right now. But you can send us an email and we'll get back to you, asap.

Not readable? Change text. captcha txt

Start typing and press Enter to search