Patient and clinician perspectives on optimizing graphical displays of longitudinal medication adherence data

Pack, Allison; Golin, Carol E.; Hill, Lauren; Carda-Auten, Jessica; Wallace, Deshira D.; Cherkur, Sruthi; Farel, Claire E; Rosen, Elias P.; Gandhi, Monica; Prince, Heather M. A.; Kashuba, Angela D. M.

doi:10.1016/j.pec.2018.12.029

Cited by 13 publications

(3 citation statements)

References 39 publications

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“…As suggested by our formative research findings [ 11 , 12 ], after the hair sample was run in the IR-MALDESI instrument, the laboratory scientist generated 2 distinct visual reports of the results intended for patients ( Figure 1 ) and providers ( Figure 2 ). The patient version presented a calendar indicating whether the IR-MALDESI output from each day achieved a sufficient threshold consistent with daily dosing, whereas the provider version displayed more detailed quantification of the IR-MALDESI output with a bar chart.…”

Section: Methodsmentioning

confidence: 99%

Establishing Novel Antiretroviral Imaging for Hair to Elucidate Nonadherence: Protocol for a Single-Arm Cross-sectional Study

Poliseno¹,

Ferguson²,

Perry³

et al. 2023

JMIR Res Protoc

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Background Adherence to antiretroviral (ARV) therapy is critical for achieving HIV RNA suppression in people living with HIV and for preventing HIV infection in uninfected individuals using preexposure prophylaxis. However, a high level of adherence can be challenging to achieve for people living with HIV on lifelong ARVs and for HIV-negative individuals using daily preexposure prophylaxis who are not at daily risk for HIV infection. Current biological measures of adherence are invasive and use bioanalytical methods that do not allow for real-time feedback during a clinic visit. This study was designed to test the feasibility and acceptability of using MedViewer, a novel, minimally invasive, hair-based assay that measures longitudinal ARV drug adherence in real time and provides an output for provider-patient discussion. Objective The primary objectives were to investigate the feasibility of delivering the MedViewer results as planned, the acceptability of participation in a discussion of the MedViewer results, and the appropriateness of using MedViewer for adherence counseling. The secondary objectives were to investigate additional dimensions of feasibility, acceptability, and appropriateness of using the MedViewer test during a routine clinic visit for people with HIV. Methods The proposed study was a single-arm cross-sectional study among patients receiving HIV care and providers of HIV care in a southeastern infectious disease clinic. The study originally planned to implement the MedViewer test with 50 eligible patients who were living with HIV across 2 viral load strata (undetectable or detectable plasma HIV RNA over the previous 2 years), administer brief visit-specific questionnaires to all patient and provider participants, and conduct qualitative in-depth interviews and quantitative end-line questionnaires with a subsample of patient participants (n=30) and all provider participants. Results The Establishing Novel Antiretroviral Imaging for Hair to Elucidate Nonadherence study was funded by the National Institute of Allergy and Infectious Diseases and approved by the local institutional review board on November 4, 2019. Provider participant enrollment began on January 17, 2020, and patient participant enrollment began on January 22, 2020. Participant enrollment was halted on March 16, 2020, because of the COVID-19 pandemic (16 providers and 10 patients on study). Study activities resumed on February 2, 2021, with COVID-19 modifications approved by the local institutional review board. Participant enrollment closed on October 8, 2021, and data collection closed on November 15, 2021. In total, 36 unique patient participants, representing 37 samples, and 20 provider participants were enrolled. Data analysis and manuscript writing will take place throughout 2023. Conclusions We anticipate that the data collected through this study will provide important insights regarding the feasibility, acceptability, and appropriateness of incorporating new real-time longitudinal, minimally invasive adherence tests into routine clinical care and identify potential barriers to medication adherence among patients. Trial Registration ClinicalTrials.gov NCT04232540; https://clinicaltrials.gov/ct2/show/NCT04232540 International Registered Report Identifier (IRRID) RR1-10.2196/41188

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Section: Methodsmentioning

confidence: 99%

Establishing Novel Antiretroviral Imaging for Hair to Elucidate Nonadherence: Protocol for a Single-Arm Cross-sectional Study

Poliseno¹,

Ferguson²,

Perry³

et al. 2023

JMIR Res Protoc

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“…Both patients and providers have previously found our visual display of IR-MALDESI MSI adherence patterns to be informative [28]. This time-series of adherence offers a measurement that can be correlated with dynamic assessments of risk to determine the potential effectiveness of individual adherence patterns.…”

Section: Plos Onementioning

confidence: 98%

Mass spectrometry imaging of hair identifies daily maraviroc adherence in HPTN 069/ACTG A5305

et al. 2023

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Objective measures of adherence for antiretrovirals used as pre-exposure prophylaxis (PrEP) are critical for improving preventative efficacy in both clinical trials and real-world application. Current objective adherence measures either reflect only recent behavior (eg days for plasma or urine) or cumulative behavior (eg months for dried blood spots). Here, we measured the accumulation of the antiretroviral drug maraviroc (MVC) in hair strands by infrared matrix-assisted laser desorption electrospray ionization (IR-MALDESI) mass spectrometry imaging (MSI) to evaluate adherence behavior longitudinally at high temporal resolution. An MSI threshold for classifying daily adherence was established using clinical samples from healthy volunteers following directly observed dosing of 1 to 7 doses MVC/week. We then used the benchmarked MSI assay to classify adherence to MVC-based PrEP regimens in hair samples collected throughout the 48-week HPTN069/ACTGA5305 study. We found that only ~32% of investigated hair samples collected during the study’s active dosing period showed consistent daily PrEP adherence throughout a retrospective period of 30 days, and also found that profiles of daily individual adherence from MSI hair analysis could identify when patients were and were not taking study drug. The assessment of adherence from MSI hair strand analysis was 62% lower than adherence classified using paired plasma samples, the latter of which may be influenced by white-coat adherence. These findings demonstrate the ability of MSI hair analysis to examine daily variability of adherence behavior over a longer-term measurement and offer the potential for longitudinal comparison with risk behavior to target patient-specific adherence interventions and improve outcomes.

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“…15 Pictographs improve patient comprehension and yield better outcomes when incorporated into discharge instructions, 16 informed decision-making, 17 and medication adherence. 18 Enrollment Process. Eligible patients were identified and enrolled at their pre-operative appointments.…”

Section: Functional Peri-operative Pain Assessment Continuedmentioning

confidence: 99%

Investigation of a Novel Activity-Based Checks (ABC) Functional Pain Scale in the Postoperative Urologic Surgery Patient

Warnky¹,

Diebolt²,

Ho³

et al. 2023

kjm

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Introduction. The authors investigated a novel functional pain scale, the Activity-Based Checks (ABCs) of Pain, following open urologic surgery. The primary objectives were to establish the strength of the correlation between the ABCs and the numeric rating scale (NRS) and determine the impact of functional pain on the patient’s opioid requirements. We hypothesized that ABC score would correlate strongly with NRS and that the ABC score during hospitalization would be more closely correlated with the number of opioids prescribed and used. Methods. This prospective study included patients at a tertiary academic hospital undergoing nephrectomy and cystectomy. The NRS and ABCs were collected pre-operatively, during the inpatient stay, and at the one-week follow-up. Milligrams of morphine equivalents (MMEs) prescribed at discharge and the MME reportedly taken during the first post-operative week were recorded. Spearman's Rho was used to assess the correlation between scale variables. Results. Fifty-seven patients were enrolled. The ABCs correlated strongly with the NRS at baseline and post-operative appointments (r = 0.716, p < 0.001 and 0.643, p < 0.001). Neither the NRS nor the composite ABCs score was predictive of outpatient MME requirements; the ABCs function, “Walking outside the room” significantly correlated to MMEs taken after discharge (r = 0.471, p = 0.011). The greatest predictor of MMEs taken was the number of MMEs prescribed (0.493, p = 0.001). Conclusions. This study highlighted the importance of post-operative pain assessment that takes functional pain into consideration to evaluate pain, inform management decisions, and reduce opiate reliance. It also emphasized the strong relationship between opioids prescribed and opioids consumed.

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Patient and clinician perspectives on optimizing graphical displays of longitudinal medication adherence data

Cited by 13 publications

References 39 publications

Establishing Novel Antiretroviral Imaging for Hair to Elucidate Nonadherence: Protocol for a Single-Arm Cross-sectional Study

Establishing Novel Antiretroviral Imaging for Hair to Elucidate Nonadherence: Protocol for a Single-Arm Cross-sectional Study

Mass spectrometry imaging of hair identifies daily maraviroc adherence in HPTN 069/ACTG A5305

Investigation of a Novel Activity-Based Checks (ABC) Functional Pain Scale in the Postoperative Urologic Surgery Patient

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