Reducing anticholinergic medication exposure among older adults using consumer technology: Protocol for a randomized clinical trial

Abebe, Ephrem; Campbell, Noll L.; Clark, Daniel O.; Tu, Wanzhu; Hill, John L.; Harrington, Addison B; O'Neal, Gracen; Trowbridge, Kimberly S.; Vallejo, Christian; Yang, Ziyi; Bo, Na; Knight, Alexxus; Alamer, Khalid; Carter, Allie; Valenzuela, Robin; Adeoye, Philip; Boustani, Malaz; Holden, Richard J.

doi:10.1016/j.sapharm.2020.10.010

Cited by 8 publications

(8 citation statements)

References 46 publications

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“…Thirteen (32.5%) of the communication tools developed or studied were tested. [15][16][17][18][19][20][21][22][23][24][25][26][27] The majority (n = 25, 62.5%) of the tools was not tested or validated, with only one tool, the EMPOWER brochure, 28 validated, and the OPTIMIZE trial tool was in the process of being validated. 29 Communication tools were categorized according to whether they targeted patients or clinicians.…”

Section: Resultsmentioning

confidence: 99%

“…Most tools were mainly intended for patients and generally focused on providing education about the risks and benefits of medications, and how to have conversations about deprescribing. [15][16][17][18][19][21][22][23][24][26][27][28][29][30][31][32][33][34][35][36] There were 13 resources identified for clinicians 5,25,[37][38][39][40][41][42][43][44][45][46][47] and two tools that targeted clinicians and patients. 17,20 Very few tools were validated or tested in target populations indicating the need for further research.…”

Section: Discussionmentioning

confidence: 99%

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Categorization of deprescribing communication tools: A scoping review

Chan

Isenor

Kennie‐Kaulbach

2023

Basic Clin Pharma Tox

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BackgroundDeprescribing can be beneficial to a wide variety of patients but is often not done due to barriers including lack of time and challenges starting conversations.ObjectivesThis study aimed to identify and broadly categorize existing deprescribing communication tools for clinicians and patients.MethodsOur scoping review protocol was based on the Arksey and O'Malley methods and incorporated the Levac and Joanna Briggs Institute recommendations. EMBASE, CINAHL, PsycINFO, MEDLINE, and grey literature were searched, with two independent reviewers assessing eligibility. A backwards search of the texts chosen for full text screen was completed. Two reviewers independently completed data extraction using a pre‐specified data collection form.FindingsDatabases identified 1121 results, searching of grey literature identified 49 results, and backwards searching identified 1323 results. After screening, 32 resources were included which contained 40 unique tools. Most tools were Canadian and targeted adults over 65 years old living in the community. Most tools had not been tested in the intended patient audience or evaluated for effectiveness.DiscussionDeprescribing tools have been developed to facilitate conversations by providing structure, education, and decision‐making approaches. More research is needed to test the effectiveness of existing tools.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Categorization of deprescribing communication tools: A scoping review

Chan

Isenor

Kennie‐Kaulbach

2023

Basic Clin Pharma Tox

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“…Project C occurred in the context of the Brain Safe randomized clinical trial, described in depth elsewhere [ 30 ]. The study enrolled adults aged 60 years or older in Indiana, USA, who were using medications with anticholinergic effects that may increase risk to brain health for older adults.…”

Section: Methodsmentioning

confidence: 99%

“…Whereas the score calculator in the Med Safe app merely calculated the total number of medications, the Brain Safe app calculated a brain harm risk score, let users simulate the effect on risk of adding or removing anticholinergic medications, showed alternative treatments, and helped users start a conversation with their health care professionals about medication safety. Additional detail on features, design, development, and prior testing are available elsewhere [ 30 , 31 ].…”

Section: Methodsmentioning

confidence: 99%

Going Remote—Demonstration and Evaluation of Remote Technology Delivery and Usability Assessment With Older Adults: Survey Study

Hill¹,

Harrington²,

Adeoye³

et al. 2021

JMIR Mhealth Uhealth

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Background The COVID-19 pandemic necessitated “going remote” with the delivery, support, and assessment of a study intervention targeting older adults enrolled in a clinical trial. While remotely delivering and assessing technology is not new, there are few methods available in the literature that are proven to be effective with diverse populations, and none for older adults specifically. Older adults comprise a diverse population, including in terms of their experience with and access to technology, making this a challenging endeavor. Objective Our objective was to remotely deliver and conduct usability testing for a mobile health (mHealth) technology intervention for older adult participants enrolled in a clinical trial of the technology. This paper describes the methodology used, its successes, and its limitations. Methods We developed a conceptual model for remote operations, called the Framework for Agile and Remote Operations (FAR Ops), that combined the general requirements for spaceflight operations with Agile project management processes to quickly respond to this challenge. Using this framework, we iteratively created care packages that differed in their contents based on participant needs and were sent to study participants to deliver the study intervention—a medication management app—and assess its usability. Usability data were collected using the System Usability Scale (SUS) and a novel usability questionnaire developed to collect more in-depth data. Results In the first 6 months of the project, we successfully delivered 21 care packages. We successfully designed and deployed a minimum viable product in less than 6 weeks, generally maintained a 2-week sprint cycle, and achieved a 40% to 50% return rate for both usability assessment instruments. We hypothesize that lack of engagement due to the pandemic and our use of asynchronous communication channels contributed to the return rate of usability assessments being lower than desired. We also provide general recommendations for performing remote usability testing with diverse populations based on the results of our work, including implementing screen sharing capabilities when possible, and determining participant preference for phone or email communications. Conclusions The FAR Ops model allowed our team to adopt remote operations for our mHealth trial in response to interruptions from the COVID-19 pandemic. This approach can be useful for other research or practice-based projects under similar circumstances or to improve efficiency, cost, effectiveness, and participant diversity in general. In addition to offering a replicable approach, this paper tells the often-untold story of practical challenges faced by mHealth projects and practical strategies used to address them. Trial Registration ClinicalTrials.gov NCT04121858; https://clinicaltrials.gov/ct2/show/NCT04121858

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“…More specifically, human factors science and practice can contribute to investigations of the deprescribing work system and process, intervention design projects, and evaluations of deprescribing initiatives. The opportunities for human factors in deprescribing have been argued implicitly in several deprescribing projects led by human factors experts (e.g., Abebe et al, 2020) and explicitly in recent commentaries (e.g., Holden & Abebe, 2021;Xiao & Young, 2021). There appears to be some demand for human factors expertise among others working in deprescribing, but the demand is not universal and may not be explicitly stated.…”

Section: Human Factors and Deprescribingmentioning

confidence: 99%

Human-Centered Design and Research in Deprescribing

Holden

Hill

Campbell

et al. 2021

Proceedings of the Human Factors and Ergonomics Society Annual

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Deprescribing is the process of withdrawing or replacing medications to improve outcomes and reduce medication-associated risks. Deprescribing, though traditionally the domain of healthcare professionals, is now receiving attention from human factors experts. In turn, the deprescribing community is gaining an appreciation for human-centered design and research. This panel gathers experts in human factors and pharmacy to critically discuss past, current, and future work concerning human-centered design and research in deprescribing. The panel will help formulate the value proposition for human factors in this important area.

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Reducing anticholinergic medication exposure among older adults using consumer technology: Protocol for a randomized clinical trial

Cited by 8 publications

References 46 publications

Categorization of deprescribing communication tools: A scoping review

Categorization of deprescribing communication tools: A scoping review

Going Remote—Demonstration and Evaluation of Remote Technology Delivery and Usability Assessment With Older Adults: Survey Study

Human-Centered Design and Research in Deprescribing

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