Tailored Mobile Health Technologies May May Improve Medication Safety In CKD

Results of a new study published in the Clinical Journal of the American Society of Nephrology found only a five percent error rate when chronic kidney disease patients were provided with custom-tailored mobile health technologies designed to enhance appropriate use of medications.

Many people find it difficult to stay on schedule take medications,and it can be particularly so for patients dealing with complex chronic diseases. However, a study to be published in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN) found that tailored mobile health technologies can help ensure better adherence and compliance with patients who are responsible for taking their own medications.

The study, entitled Remote Usability Testing and Satisfaction with a Mobile Health Medication Inquiry System in CKD is coauthored by Clarissa J. Diamantidis Duke University of School of Medicine and the Durham Veterans Affairs Medical Center in Durham, North Carolina; Jennifer S. Ginsberg, Marni Yoffe, Lisa Lucas and Jeffrey C. Fink of the University of Maryland School of Medicine departments of Epidemiology and Public Health in Baltimore, Maryland; Divya Prakash of Data Warehouse and Analytics, St. Joseph Health System, Anaheim, California; Saurabh Aggarwal and Wanda Fink, Principal and Co-Founder of Novel Health Strategies, LLC, Columbia, Maryland; and Stefan Becker of the Institute for Drug Safety, Department of Nephrology, University Hospital Essen, Essen, Germany. Jeffrey C. Fink is also associated with the Department of Medicine, Veterans Affairs Maryland Health Care System at Baltimore, Maryland, and has received prior research funding from Amgen, Inc. and honoraria from Sandoz, Inc. and Amgen, Inc.

Given that inappropriate medication use is common in care of patients with CKD, the investigators’ objective with this study was to examine the feasibility of using a simple mobile health tool designed to advise patients on safe medication usage in CKD.

To determine whether user-friendly mobile technologies might help keep patients with chronic kidney disease (CKD) on track with their medications, Clarissa Jonas Diamantidis, MD, MHS, of the Duke University School of Medicine, and her colleagues at the University of Maryland School of Medicine evaluated the home-based usability of a mobile health medication inquiry system (MIS) that they designed as a patient-centered medication safeguard.

Twenty participants with predialysis CKD in the Safe Kidney Care Cohort Study were recruited for home usability testing of the novel medication inquiry system between January and September of 2013. Testing was through two mobile platforms: 1) short messaging service text, or 2) using a personal digital assistant (e.g., iPod Touch).

One half of the participants were assigned to one device and the other half to the other device, and received an in-center tutorial on device usage before the end of the study visit. Participants were subsequently mailed three sample pill bottles labeled with the names of randomly selected medications and asked to input these medications into the medication inquiry system. The medication inquiry system response options were as follows: 1) safe in CKD, 2) not safe in CKD, 3) use with caution/speak with your health care provider, or 4) error message (for an incorrectly inputted medication). Participants were asked to record their responses issued by the medication inquiry system for each medication sent for usability testing. A user satisfaction survey was administered after completion of the protocol.

The researchers found that all participants owned a mobile telephone, but few owned a smartphone. Of 60 total medication queries, there were only three recorded errors, two of which occurred in the short messaging service texting group. Overall satisfaction with the application was high, with slightly higher satisfaction noted in the personal digital assistant group compared with the short messaging service group.

Based on these findings, the mobile health medication inquiry system application was shown to have general ease of use and high acceptance across two platforms among individuals representative of the CKD population, indicating that tailored mobile health technology may improve medication safety in CKD.

DiamantidesC“General usability of the MIS application was high, regardless of platform type, with only a five percent error rate,” says Dr. Diamantidis in a release. Two errors occurred in the text-based group and 1 in the PDA-based group. The majority of participants reported finding the application easy to use and helpful in avoiding use of harmful medications, and said they would recommend the application to others.

Dr. Diamantidis is a clinical investigator with interest in the use of health information technology to engage high risk patients with chronic kidney disease in an effort to improve patient safety. Her clinical time is spent in the Division of Nephrology at the VA,

Despite the enrolees’ general proficiency with the mobile health MIS application, the study did uncover variable electronic health literacy among patients. When participants were administered the eHealth Literacy Scale, which evaluates individuals’ perceived abilities to effectively apply electronic health information to health problems, a majority of participants felt the Internet was a useful source of health information, but only about half felt they knew where to find helpful health resources online, and even fewer reported being able to tell high quality from low quality Internet-based health information.

BeckerBIn an accompanying Clinical Journal of the American Society of Nephrology editorial (Medication Safety Mobile Health = Patient Engagement in Chronic Kidney Disease., July 2015 DOI: 10.2215/CJN.06970615) Bryan Becker, MD, of the University of Chicago, notes that harnessing mobile technology to better treat CKD is logical. “What Dr. Diamantidis and colleagues have done is extend that treatment platform beyond traditional care settings into the home,” Dr. Becker writes. “They have used a tool to create a small but very important first step in achieving patient engagement and patient satisfaction in self-care.”

The article, “Remote Usability Testing and Satisfaction with a Mobile Health Medication Inquiry System in CKD,” was published online at http://cjasn.asnjournals.org/ on July 28, 2015, with Dr. Becker’s editorial also appearing onappeline at http://cjasn.asnjournals.org/ that same date.

Dr. Diamantidis was also involved in a previous prospective study at the University of Maryland, entitled Safe Kidney Care, examining the frequency of adverse safety events in individuals with pre-dialysis chronic kidney disease. As part of that study, participants were encouraged to log into a website which provided information of important safety concepts in kidney disease (for example, avoidance of NSAIDs).

The investigators were able to track how often participants logged into the website and which safety modules they visited most frequently. About 30 percent of invited participants logged in, which Dr. Diamantidis notes is actually a bit higher than other studies, and as it turns out, most participants were interested in calculating their renal function. She is working on a similar study where investigators will have the ability to track users of a website to assess their computer literacy and patient safety knowledge.

American Society of Nephrology (ASN)
Clinical Journal of the American Society of Nephrology (CJASN)
Duke University of School of Medicine

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Duke University of School of Medicine
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Charles Moore has a long-proven track record in both print and digital journalism, touching on a wide range of subjects, from biotech and healthcare to politics and technology. He contributes substantial feature articles research and development for the news site, particularly pertaining to technology.

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