Digital Medicine System in Veterans With Severe Mental Illness: Feasibility and Acceptability Study.
| dc.contributor.author | Gonzales, Sarah | |
| dc.contributor.author | Okusaga, Olaoluwa O | |
| dc.contributor.author | Reuteman-Fowler, J Corey | |
| dc.contributor.author | Oakes, Megan M | |
| dc.contributor.author | Brown, Jamie N | |
| dc.contributor.author | Moore, Scott | |
| dc.contributor.author | Lewinski, Allison A | |
| dc.contributor.author | Rodriguez, Cristin | |
| dc.contributor.author | Moncayo, Norma | |
| dc.contributor.author | Smith, Valerie A | |
| dc.contributor.author | Malone, Shauna | |
| dc.contributor.author | List, Justine | |
| dc.contributor.author | Cho, Raymond Y | |
| dc.contributor.author | Jeffreys, Amy S | |
| dc.contributor.author | Bosworth, Hayden B | |
| dc.date.accessioned | 2023-08-09T14:39:46Z | |
| dc.date.available | 2023-08-09T14:39:46Z | |
| dc.date.issued | 2022-12 | |
| dc.date.updated | 2023-08-09T14:39:46Z | |
| dc.description.abstract | BackgroundSuboptimal medication adherence is a significant problem for patients with serious mental illness. Measuring medication adherence through subjective and objective measures can be challenging, time-consuming, and inaccurate.ObjectiveThe primary purpose of this feasibility and acceptability study was to evaluate the impact of a digital medicine system (DMS) among Veterans (patients) with serious mental illness as compared with treatment as usual (TAU) on medication adherence.MethodsThis open-label, 2-site, provider-randomized trial assessed aripiprazole refill adherence in Veterans with schizophrenia, schizoaffective disorder, bipolar disorder, or major depressive disorder. We randomized 26 providers such that their patients either received TAU or DMS for a period of 90 days. Semistructured interviews with patients and providers were used to examine the feasibility and acceptability of using the DMS.ResultsWe enrolled 46 patients across 2 Veterans Health Administration sites: 21 (46%) in DMS and 25 (54%) in TAU. There was no difference in the proportion of days covered by medication refill over 3 and 6 months (0.82, SD 0.24 and 0.75, SD 0.26 in DMS vs 0.86, SD 0.19 and 0.82, SD 0.21 in TAU, respectively). The DMS arm had 0.85 (SD 0.20) proportion of days covered during the period they were engaged with the DMS (mean 144, SD 100 days). Interviews with patients (n=14) and providers (n=5) elicited themes salient to using the DMS. Patient findings described the positive impact of the DMS on medication adherence, challenges with the DMS patch connectivity and skin irritation, and challenges with the DMS app that affected overall use. Providers described an overall interest in using a DMS as an objective measure to support medication adherence in their patients. However, providers described challenges with the DMS dashboard and integrating DMS data into their workflow, which decreased the usability of the DMS for providers.ConclusionsThere was no observed difference in refill rates. Among those who engaged in the DMS arm, the proportion of days covered by refills were relatively high (mean 0.85, SD 0.20). The qualitative analyses highlighted areas for further refinement of the DMS.Trial registrationClinicalTrials.gov NCT03881449; https://clinicaltrials.gov/ct2/show/NCT03881449. | |
| dc.identifier | v6i12e34893 | |
| dc.identifier.issn | 2561-326X | |
| dc.identifier.issn | 2561-326X | |
| dc.identifier.uri | ||
| dc.language | eng | |
| dc.publisher | JMIR Publications Inc. | |
| dc.relation.ispartof | JMIR formative research | |
| dc.relation.isversionof | 10.2196/34893 | |
| dc.subject | ABILIFY MYCITE | |
| dc.subject | Veterans | |
| dc.subject | adherence | |
| dc.subject | aripiprazole | |
| dc.subject | digital medicine | |
| dc.subject | medication | |
| dc.subject | mental health | |
| dc.subject | mental illness | |
| dc.subject | mobile phone | |
| dc.subject | qualitative methods | |
| dc.title | Digital Medicine System in Veterans With Severe Mental Illness: Feasibility and Acceptability Study. | |
| dc.type | Journal article | |
| duke.contributor.orcid | Lewinski, Allison A|0000-0002-1356-1857 | |
| duke.contributor.orcid | Smith, Valerie A|0000-0001-5170-9819 | |
| duke.contributor.orcid | Bosworth, Hayden B|0000-0001-6188-9825 | |
| pubs.begin-page | e34893 | |
| pubs.issue | 12 | |
| pubs.organisational-group | Duke | |
| pubs.organisational-group | School of Medicine | |
| pubs.organisational-group | School of Nursing | |
| pubs.organisational-group | Staff | |
| pubs.organisational-group | Basic Science Departments | |
| pubs.organisational-group | Clinical Science Departments | |
| pubs.organisational-group | Institutes and Centers | |
| pubs.organisational-group | Medicine | |
| pubs.organisational-group | Psychiatry & Behavioral Sciences | |
| pubs.organisational-group | Medicine, General Internal Medicine | |
| pubs.organisational-group | Duke Cancer Institute | |
| pubs.organisational-group | Duke Clinical Research Institute | |
| pubs.organisational-group | Institutes and Provost's Academic Units | |
| pubs.organisational-group | University Institutes and Centers | |
| pubs.organisational-group | Duke Institute for Brain Sciences | |
| pubs.organisational-group | Center for the Study of Aging and Human Development | |
| pubs.organisational-group | Initiatives | |
| pubs.organisational-group | Duke Science & Society | |
| pubs.organisational-group | Population Health Sciences | |
| pubs.organisational-group | Duke Innovation & Entrepreneurship | |
| pubs.organisational-group | Psychiatry & Behavioral Sciences, Behavioral Medicine & Neurosciences | |
| pubs.organisational-group | Psychiatry & Behavioral Sciences, Adult Psychiatry & Psychology | |
| pubs.organisational-group | Duke - Margolis Center For Health Policy | |
| pubs.publication-status | Published | |
| pubs.volume | 6 |
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