Medication+Adherence

**Project Proposal **  Medication adherence is defined as the extent to which patients take medications as prescribed by their doctors. Therefore, medication adherence applies to anyone being prescribed medicine, whether it is the patient or caregiver taking care of the patient. Medicine regimens are difficult for all patients and especially challenging for the elderly. As average life expectancy increases, so does the increase in chronic diseases in the elderly. According to the article, //Ability of older people with dementia or cognitive impairment to manage medicine regimen,// “impaired cognition has a significant impact on a person’s ability to manage their medicines.” Patients who have chronic diseases are taking multiple medications at a time so it is important to track the medications and make sure they do not counter-act with one another. In case the elderly cannot take care of themselves it is important that their caretakers know when to administer the medication properly and what medicines counter-act with the patient’s prescription. Beside the caretaker, the patient’s doctors needs to keep track of the medicine is they are prescribing. It is vital that the doctor does not wrongly diagnose or mix up medications for the patient. Any number of small errors can cause the patient great harm.
 * Michael Kennedy **
 * Winston Jones **
 * Lauren Potter **
 * Ryan Lanes **
 * LIS 4785 **
 * Dr. Sanghee Oh, Ph.D **
 * September 22, 2015 **
 * Who? **

 The main issue that our research and project is directed towards is poor medication adherence. Poor medication adherence means that a patient is, for some reason or another, not taking all of their prescribed medication(s). This issue is widespread and can have a huge effect on a patient’s treatment. Some of the causes of this issue are forgetfulness, a misunderstanding of the prescribed medication regimen, and inability to afford the necessary treatment. Some of these causes can be helped using existing eHealth technologies.
 * What? **

 The sooner we can implement these functions into our daily lives the better. Users of this app would be able to access their personal health information at a moment’s notice thus saving them time and money. Many of the technologies required to achieve this goal have already been in use for several years. It now rests in the hands of application developers to design a fluid and simplistic way to self-monitor one’s personal health records from their computers and smartphones. Assuming that a digital health application did offer features such as accurate prescription auto-refills and text/e-mail notifications, this technology could potentially be used for decades, or at least until the next groundbreaking technology revolutionizes healthcare.
 * When? **

 Proper medication adherence is a globally recognized issue which is the result of miscommunication between hospitals, health organizations, and patients themselves. With the help of a mobile device to organize and update a person’s health records, we can hopefully reduce the amount of unnecessary trips to the doctor’s office or pharmacy. This will also prove to be very beneficial to those who are unable to travel frequently due to health-related issues. Currently, the only areas in which this technology would not benefit society as a whole are places in which electronic health records simply don’t exist or have just recently started compiling digital patient information.
 * Where? **

<span style="color: #333333; font-family: 'Times New Roman','serif'; font-size: 16px;"> Current technology presents an opportunity to improve the quality of care received by patients. Medication adherence greatly affects patient outcomes. Patient’s adherence to prescriptions is always a positive. Creating this PHR application would allow the collection of of more information for public health record. The level of medication adherence can be monitored and and examined. This examination could lead to more discoveries about actual medication adherence and the quality of care that patients are not only receiving, but creating for themselves.
 * <span style="color: #333333; font-family: 'Times New Roman','serif'; font-size: 16px;">Why? **


 * <span style="font-family: Arial,sans-serif; font-size: 11pt;">Problem Statement: **
 * <span style="color: #333333; font-family: 'Times New Roman',serif; font-size: 12pt;">Poor medication adherence means that a patient is, for some reason or another, not taking all of their prescribed medication(s)
 * <span style="color: #333333; font-family: 'Times New Roman',serif; font-size: 12pt;">Poor medication adherence can increase likelihood of preventable disease progression, increased hospitalizations, avoidable doctor and emergency room visits, and other results from poor health.
 * o <span style="color: #333333; font-family: 'Times New Roman',serif; font-size: 12pt;">Approximately 125,000 Americans die per year because of complications from poor medication adherence
 * o <span style="color: #333333; font-family: 'Times New Roman',serif; font-size: 12pt;">Half of all patients do not take their medications as prescribed
 * o <span style="color: #333333; font-family: 'Times New Roman',serif; font-size: 12pt;">According to the NEHI, proper medication adherence and disease management could save up to $290 billion per year, which equates 13% of health spending in the nation

<span style="color: #333333; font-family: 'Times New Roman',serif;">According to our research, patients that are prescribed self-administered medications typically only take half of their doses (Nieuwlaat et al., 2014). Adhering to a prescription is critical in many treatment plans, especially those of patients with chronic illnesses. The results of poor medication adherence in patients with chronic illnesses can be a faster progression in the illness, improper medical treatment, and ultimately death. <span style="color: #333333; font-family: 'Times New Roman',serif;">One crucial thing to pay attention to when on multiple medications is the potential risk of the medications having an adverse effect on the patient. Adverse medication reactions account for a third of all adverse events in hospitals, and the issue is almost completely preventable. The government has taken action by spreading awareness and making health resources widely available in the hopes to decrease the amount of deaths due to adverse drug reactions (Harris, Hu, Lee, Mistry, York, & Johnson, 2015).
 * <span style="font-family: Arial,sans-serif; font-size: 11pt;">Evidence to support the problem: **

<span style="font-family: Arial,sans-serif; font-size: 11pt;"> Mobile Application with the following functionalities:
 * <span style="font-family: Arial,sans-serif; font-size: 11pt;">Potential solution (3-5) **
 * <span style="font-family: Arial,sans-serif; font-size: 11pt;">set medication schedules with alerts
 * <span style="font-family: Arial,sans-serif; font-size: 11pt; line-height: 1.5;">store information about the user’s medication adherence (exportable)
 * <span style="font-family: Arial,sans-serif; font-size: 11pt;">create user profile to store information about them
 * <span style="font-family: Arial,sans-serif; font-size: 11pt; line-height: 1.5;">sociodemographic information
 * <span style="font-family: Arial,sans-serif; font-size: 11pt;">physical information
 * <span style="font-family: Arial,sans-serif; font-size: 11pt; line-height: 1.5;">medical history
 * <span style="font-family: Arial,sans-serif; font-size: 11pt;">provide access to community resources
 * <span style="font-family: Arial,sans-serif; font-size: 11pt;">connection to forums related to user’s health conditions/treatments


 * Feasibility of Each Solution**
 * 1) <span style="font-family: Arial,sans-serif; font-size: 11pt;">This functionality is definitely attainable with some coding. We would need to format our data to allow it to be exported in multiple formats.
 * 2) <span style="font-family: Arial,sans-serif; font-size: 11pt;">This will be a bit more complex, but it will certainly be worth it as this information will help us understand our demographic and help with user feedback and forum posting.
 * 3) <span style="font-family: Arial,sans-serif; font-size: 11pt;">Providing access to community resources will be a bit more complex, but the feature is necessary as it enables the user to connect with others and share useful information with their groups

<span style="font-family: Arial,sans-serif; font-size: 11pt;"> Most of our proposed solutions are very achievable with a bit of coding. Some of our functionalities will require some more complex code that is beyond our personal levels of experience, but that is resolved with outsourcing the coding. However, we need to take into account the security measures that are necessary to protect our users’ information. Another major thing that we have not yet taken into consideration are the HIPPA laws that would apply to our application. We would most likely need a lawyer specialized in this field to consult with, and we would definitely need to work closely with developers of EHR/PHR systems to make sure that we impose data standards on our system.


 * <span style="font-family: Arial,sans-serif; font-size: 11pt;">Research on existing / alternate solutions **

**<span style="font-family: Arial,sans-serif;">Chosen approach (reasons) **
 * <span style="font-family: 'Proxima Nova',serif;">MedSmart PLUS Monitored Automatic Medication Pill Dispenser
 * <span style="font-family: 'Proxima Nova',serif;">notifies remote caregiver when patient misses medication
 * <span style="font-family: 'Proxima Nova',serif;">phone
 * <span style="font-family: 'Proxima Nova',serif;">email
 * <span style="font-family: 'Proxima Nova',serif;">text
 * <span style="font-family: 'Proxima Nova',serif;">organizes medication
 * <span style="font-family: 'Proxima Nova',serif;">reminds patient to take it
 * <span style="font-family: 'Proxima Nova',serif;">dispenses medication on time
 * <span style="color: #1155cc; font-family: 'Proxima Nova',serif;">[]
 * <span style="font-family: 'Proxima Nova',serif;">Med Helper
 * <span style="font-family: 'Proxima Nova',serif;">mobile app
 * <span style="font-family: 'Proxima Nova',serif;">medication reminder alerts
 * <span style="font-family: 'Proxima Nova',serif;">prescription information storage
 * <span style="font-family: 'Proxima Nova',serif;">programmable schedule
 * <span style="font-family: 'Proxima Nova',serif;">stores contact information for
 * <span style="font-family: 'Proxima Nova',serif;">doctor
 * <span style="font-family: 'Proxima Nova',serif;">pharmacy
 * <span style="color: #1155cc; font-family: 'Proxima Nova',serif;">[]
 * <span style="font-family: Arial,sans-serif;">We wanted to create an app that would help users track when and if they have taken their medication. After logging in, the user will be able to scan their prescription barcode and it will go directly into the system alerting them how much to take and any specific directions correlated with that prescription.
 * <span style="font-family: Arial,sans-serif;">We also wanted to help the user track their doctor appointments. This is possible due to the calendar function in our app. They will be able to input their appointments and it will alert them 3 days in advance to make arrangements to attend their appointment.


 * <span style="font-family: Arial,sans-serif;">Timeline for completion **


 * || **<span style="font-family: 'Times New Roman',serif; font-size: 11pt;">August ** || **<span style="font-family: 'Times New Roman',serif; font-size: 11pt;">September ** || **<span style="font-family: 'Times New Roman',serif; font-size: 11pt;">October ** || **<span style="font-family: 'Times New Roman',serif; font-size: 11pt;">November ** || **<span style="font-family: 'Times New Roman',serif; font-size: 11pt;">December ** ||
 * **<span style="color: #980000; font-family: 'Times New Roman',serif; font-size: 11pt;">Group formed ** || **<span style="color: #980000; font-family: 'Times New Roman',serif; font-size: 11pt;">+++++++++ ** ||  ||   ||   ||   ||
 * **<span style="color: #6aa84f; font-family: 'Times New Roman',serif; font-size: 11pt;">Topic Selection ** ||  || **<span style="color: #93c47d; font-family: 'Times New Roman',serif; font-size: 11pt;">+++++++++ ** ||   ||   ||   ||
 * **<span style="color: #e69138; font-family: 'Times New Roman',serif; font-size: 11pt;">Two page proposal ** ||  || **<span style="color: #f6b26b; font-family: 'Times New Roman',serif; font-size: 11pt;">++++++++++ ** ||   ||   ||   ||
 * **<span style="color: #8e7cc3; font-family: 'Times New Roman',serif; font-size: 11pt;">Wiki term individual assignment ** ||  ||   || **<span style="color: #8e7cc3; font-family: 'Times New Roman',serif; font-size: 11pt;">++++++++ ** ||   ||   ||
 * **<span style="color: #a64d79; font-family: 'Times New Roman',serif; font-size: 11pt;">Research ** || **<span style="color: #a64d79; font-family: 'Times New Roman',serif; font-size: 11pt;">++++++++++ ** || **<span style="color: #a64d79; font-family: 'Times New Roman',serif; font-size: 11pt;">++++++++++ ** || **<span style="color: #a64d79; font-family: 'Times New Roman',serif; font-size: 11pt;">++++++++++ ** || **<span style="color: #a64d79; font-family: 'Times New Roman',serif; font-size: 11pt;">++++++++ ** ||  ||
 * **<span style="font-family: 'Times New Roman',serif; font-size: 11pt;">Application template demo ** ||  ||   ||   || **<span style="font-family: 'Times New Roman',serif; font-size: 11pt;">++++++++ ** ||   ||
 * **<span style="color: #3d85c6; font-family: 'Times New Roman',serif; font-size: 11pt;">Final presentation ** ||  ||   ||   || **<span style="color: #3d85c6; font-family: 'Times New Roman',serif; font-size: 11pt;">+++++++++ ** || **<span style="color: #3d85c6; font-family: 'Times New Roman',serif; font-size: 11pt;">+++++++++ ** ||
 * **<span style="color: #999999; font-family: 'Times New Roman',serif; font-size: 11pt;">Final Report ** ||  ||   ||   ||   || **<span style="color: #999999; font-family: 'Times New Roman',serif; font-size: 11pt;">+++++++++ ** ||


 * <span style="font-family: Arial,sans-serif;">Team workload and roles **
 * <span style="font-family: Arial,sans-serif;">Michael Kennedy
 * <span style="font-family: Arial,sans-serif;">created mockups
 * <span style="font-family: Arial,sans-serif;">researched
 * <span style="font-family: Arial,sans-serif;">presented
 * <span style="font-family: Arial,sans-serif;">helped compile powerpoint slides
 * <span style="font-family: Arial,sans-serif;">helped draft paper submissions
 * <span style="font-family: Arial,sans-serif;">Ryan Lanes
 * <span style="font-family: Arial,sans-serif;">created mockups
 * <span style="font-family: Arial,sans-serif;">organized meetings
 * <span style="font-family: Arial,sans-serif;">researched
 * <span style="font-family: Arial,sans-serif;">helped draft paper submissions and powerpoint slides
 * <span style="font-family: Arial,sans-serif;">presented
 * <span style="font-family: Arial,sans-serif;">Lauren Potter
 * <span style="font-family: Arial,sans-serif;">recorded meeting minutes
 * <span style="font-family: Arial,sans-serif;">facilitated communication
 * <span style="font-family: Arial,sans-serif;">presented
 * <span style="font-family: Arial,sans-serif;">created mockups
 * <span style="font-family: Arial,sans-serif;">helped draft paper submissions and powerpoint slides

**<span style="font-family: Arial,sans-serif;">Meeting minutes **
 * <span style="font-family: Arial,sans-serif; font-size: 11pt;">September 9, 2015 : We came up with a topic for our project
 * <span style="font-family: Arial,sans-serif; font-size: 11pt;">September 20, 2015: We split up tasks for the two page proposal
 * <span style="font-family: Arial,sans-serif; font-size: 11pt;">November 10, 2015: Split up tasks to create mockups
 * <span style="font-family: Arial,sans-serif; font-size: 11pt;">December 1, 2015: Met up to complete presentation PowerPoint
 * <span style="font-family: Arial,sans-serif; font-size: 11pt;">December 3, 2015: Met up to practice PowerPoint
 * <span style="font-family: Arial,sans-serif; font-size: 11pt;">December 7,2015: Met up to complete final report


 * <span style="font-family: Arial,sans-serif;">Solution prototypes **

<span style="font-family: Arial,sans-serif;"> This application was created to help our users with their medication adherence. The app allows the user to create a medication schedule (or medication schedules) that will alert them when it's time to take their medication. Set up a user profile to store personal information securely and to connect with others with similar treatments or conditions.
 * <span style="font-family: Arial,sans-serif;">Final Solution **

//<span style="font-family: Arial,sans-serif;">****December 3, 2015 Update**** // //<span style="font-family: Arial,sans-serif; font-size: 10pt;">Downloading the new version of iPillBox will include the features listed below // <span style="font-family: Arial,sans-serif;">

<span style="font-family: Arial,sans-serif;">The first is privacy. We decided to take out the social media forum because there are patients who do not want friends on Facebook knowing their medical history. Secondly, we added the option to scan their medication’s barcode. This will minimize human error and add automation to the process. This feature is mainly for the elderly or less technically savvy users. Thirdly, we added the option for the user to import the app calendar to their daily calendar. This will reduce the error of skipping doctor appointments or medications. The last feature we decided to add to the application is the messaging feature; this is a function that allows a patient to send messages directly to their caretakers within the application. This feature will enable uses to communicate with their care providers with ease with an email-like function.


 * <span style="font-family: Arial,sans-serif;">Next st ****<span style="font-family: Arial,sans-serif; font-size: 11pt;">eps **
 * <span style="font-family: Arial,sans-serif; font-size: 11pt;">research HIPPA laws
 * <span style="font-family: Arial,sans-serif; font-size: 11pt;">integrate PHR systems
 * <span style="font-family: Arial,sans-serif; font-size: 11pt;">testing prototype
 * <span style="font-family: Arial,sans-serif; font-size: 11pt;">revise and test again
 * <span style="font-family: Arial,sans-serif; font-size: 11pt;">launch application

<span style="font-family: 'Times New Roman',serif; font-size: 10pt;">FAU, E. R., Goeman, D., Beanland, C. F., & Koch, S. (0904). Ability of older people with dementia or
 * <span style="font-family: Arial,sans-serif; font-size: 11pt;">Citations **

<span style="font-family: 'Times New Roman',serif; font-size: 10pt;"> cognitive impairment to manage medicine regimens: A narrative review.

<span style="font-family: 'Times New Roman',serif; font-size: 10pt;">Harris, Y., Hu, D. J., Lee, C., Mistry, M., York, A., & Johnson, T. K. (2015). Advancing medication safety: <span style="font-family: 'Times New Roman',serif; font-size: 10pt;"> Establishing a national action plan for adverse drug event prevention. Joint Commission Journal

<span style="font-family: 'Times New Roman',serif; font-size: 10pt;"> on Quality and Patient Safety / Joint Commission Resources, 41(8), 351-360.

<span style="font-family: 'Times New Roman',serif; font-size: 10pt;">Nieuwlaat, R., Wilczynski, N., Navarro, T., Hobson, N., Jeffery, R., Keepanasseril, A.,. . . Haynes, R. B. <span style="font-family: 'Times New Roman',serif; font-size: 10pt;"> (2014). Interventions for enhancing medication adherence.//The Cochrane Database of Systematic//

//<span style="font-family: 'Times New Roman',serif; font-size: 10pt;"> Reviews, 11 //<span style="font-family: 'Times New Roman',serif; font-size: 10pt;">, CD000011. doi:10.1002/14651858.CD000011.pub4 [doi]