Rethinking agency and medical adherence technology: applying Actor Network Theory to the case study of Digital Pills

Hurtado‐de‐Mendoza, Alejandra; Cabling, Mark L.; Sheppard, Vanessa B.

doi:10.1111/nin.12101

Cited by 5 publications

(4 citation statements)

References 49 publications

(96 reference statements)

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“…The alternative view is that such monitoring (especially digital) is part of information society that individuals are willing to be part of and thus gain personal benefit [64]. From the clinical point of view, ignoring or ineffective way of testing for non-adherence will result in unnecessary treatment escalations and additional investigations, many of which carry risks.…”

Section: The Ethical Clinical and Economic Aspects Of Screening For mentioning

confidence: 99%

How to Screen for Non-Adherence to Antihypertensive Therapy

et al. 2016

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The quality of assessment of non-adherence to treatment in hypertensive is poor. Within this review, we discuss the different methods used to assess adherence to blood-pressure-lowering medications in hypertension patients. Subjective reports such as physicians’ perceptions are inaccurate, and questionnaires completed by patients tend to overreport adherence and show a low diagnostic specificity. Indirect objective methods such as pharmacy database records can be useful, but they are limited by the robustness of the recorded data. Electronic medication monitoring devices are accurate but usually track adherence to only a single medication and can be expensive. Overall, the fundamental issue with indirect objective measures is that they do not fully confirm ingestion of antihypertensive medications. Detection of antihypertensive medications in body fluids using liquid chromatography–tandem mass spectrometry is currently, in our view, the most robust and clinically useful method to assess non-adherence to blood-pressure-lowering treatment. It is particularly helpful in patients presenting with resistant, refractory or uncontrolled hypertension despite the optimal therapy. We recommend using this diagnostic strategy to detect non-adherence alongside a no-blame approach tailoring support to address the perceptions (e.g. beliefs about the illness and treatment) and practicalities (e.g. capability and resources) influencing motivation and ability to adhere.

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Section: The Ethical Clinical and Economic Aspects Of Screening For mentioning

confidence: 99%

How to Screen for Non-Adherence to Antihypertensive Therapy

et al. 2016

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“…Many women reported talking to their providers about their decisions to stop taking AET; in some cases, the providers recommended that women discontinue their AET. While clinicians commonly recognize the burden and effects of AET symptoms, limited efforts have been developed that seek enhance patient-provider communication in this area [15]. Training physicians and/or other members of the medical team on communication with the patients may enhance symptom management and reduce non-adherence and discontinuation rates [16].…”

Section: Discussionmentioning

confidence: 99%

“I did not need anything else to make me feel bad”: The precarious paradox of Breast Cancer Survivors’ adherence to adjuvant endocrine therapy

Sheppard

Namoos

Bonny

et al. 2022

Preprint

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Adherence to adjuvant endocrine therapy (AET) is a critical problem in the treatment of hormone receptorpositive (HR+) breast cancer (BC). More than half of women discontinue AET prior to the end of the recommended 5-year course of therapy. The purpose of this study was to assess the feasibility of engaging women in research who prematurely discontinued AET and to describe their experiences with AET to inform future interventions. MethodsA mixed-methods pilot study was nested within a larger observational trial of women with HR + BC (N = 594). Women who discontinued therapy were systematically identi ed over 24 months; quantitative surveys and in-depth interviews were conducted. Paired t-tests were used to compare the mean difference in psychosocial factors and medication-related symptoms between baseline and discontinuation timepoints.In-depth open-ended interviews were audio-recorded, transcribed verbatim, and analyzed using the NVivo software program. ResultsMost women (90%) who discontinued AET during the observational period participated in the study (N = 37). Women's ages ranged from 46 to 78 years old (m = 60.1); 62.2% were White, 29.7% were Black and the remaining women identi ed as being from other racial/ethnic groups. Few differences were noted between women who did and did not discontinue AET. Most women (84%) reported AET-side effects as a reason for discontinuation. Among those who discontinued, the reported vasomotor symptoms were lower at discontinuation compared to the rst symptom assessment (P = 0.0047). Qualitative data suggested frustration with strategies to address symptoms, being unprepared for the intensity of symptoms, and a desire for better patient-provider communication. 69.2% of women reported that would be willing to consider restarting AET if barriers were removed. ConclusionMost women were willing to restart AET. Capturing women's experiences while on treatment and their discontinuation in real-time may help women prevent discontinuation, enhance the quality of life and prevent worsening of medication-related symptoms. Interventions that integrate patients' concerns with symptom management and enhance patient-physician communication may support AET adherence.

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“…Poor medication adherence can result in negative health consequences, decreased quality of life, and increased healthcare costs [ 1 , 7 ]. Relapse and hospitalization are major consequences of non-adherence in individuals with schizophrenia [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Ingestible Sensors and Medication Adherence: Focus on Use in Serious Mental Illness

2020

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Background: Poor medication adherence is a major public health concern. Patients living with a serious mental illness (SMI) commonly present with non-adherence to their medication regimen, which can lead to relapse and hospitalizations. The high rates of antipsychotic non-adherence continue to persist despite several interventions and medication advances. This review evaluates the possible role of the ingestible sensor technology for medication adherence in different conditions, with a focus on use in the SMI schizophrenia. Methods: Literature searches were conducted in July 2019 in the PubMed database. Results: In small studies of ingestible sensor use, the average adherence ranged from 73.9% to 88.6% for SMI and ≥ 80% for cardiac and transplant (99.4%) patients. In SMI studies, patients were clinically stable, and the majority had a clinical global impression severity of “mild disease”. Patients generally experienced relatively minor dermatological adverse effects related to wearable sensor use. Conclusions: A medication with an ingestible sensor may help provide real-time objective medication-taking adherence information for clinicians. However, further studies are needed to understand the impact of use on adherence and improvement on treatment outcomes with the ingestible sensor technology.

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Rethinking agency and medical adherence technology: applying Actor Network Theory to the case study of Digital Pills

Cited by 5 publications

References 49 publications

How to Screen for Non-Adherence to Antihypertensive Therapy

How to Screen for Non-Adherence to Antihypertensive Therapy

“I did not need anything else to make me feel bad”: The precarious paradox of Breast Cancer Survivors’ adherence to adjuvant endocrine therapy

Ingestible Sensors and Medication Adherence: Focus on Use in Serious Mental Illness

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