Category: Literature Review

PHRs in YouTube

A PHR typically comprises of demographic info, physical exam and medical history, clinical and hospital discharge notes, diagnostics test results and medications.

From the lit review we identified some PHR attributes that are related to medication adherence. PHRs have other attributes for example bill viewing and payment, drug to drug interaction systems, immunization records etc. We do not argue that these attributes do not help with medication adherence, we are simply stating the fact that we did not find evidence in the literature that they do so. The included attributes as well as others that we might omit i.e. bill viewing, assist patients with the general purpose of PHR which is to decrease care cost and make the management of diseases easier.

 

Data gathering

We developed a data extraction sheet (based on the data extraction forms for qualitative studies National Institute for Health and Care Excellence (NICE) [1] and the data extraction chapter from the Cochrane Collaboration [2]), pilot-tested it on ten randomly-selected included studies, and refined it accordingly. One review author extracted the following data from included studies and the second author checked the extracted data. Disagreements were resolved by discussion between the two review authors; if no agreement could be reached, it was planned a third author would decide. We contacted two authors for further information, one of them responded and clarified the type of data that were presented in the paper.

 

 

 

References

1          Nice SCI for E. Data extraction forms for qualitative studies. In: A NICE-SCIE Guideline on Supporting People With Dementia and Their Carers in Health and Social Care. The British Psychological Society and Gaskell 2006. 66–8. doi:978-1-85433-451-0

2           Noyes J, Hannes K, Booth A, et al. Qualitative research and Cochrane reviews. In: Higgins JPT, Green S, eds. Cochrane Handbook for Systematic Reviews of Interventions Version 5.3.0 (updated October 2015). The Cochrane Collaboration 2015. http://qim.cochrane.org/supplemental-handbook-guidance

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Thoughts on literature review assessment process

Again these are my personal thoughts and opinions.

  • In case of doubt I include the study
  • There is a lot of IT research in the field, but developers design a system and they do not seem to test it in practice. They just claim that improves medication adherence.
  • HIV/AIDS is now often characterized as a chronic yet manageable disease.
  • The publications do not typically mention the term PHR but they state something similar to “mobile application linked to the GP” and any imaginative variation of this sentence; thus I think a very clear PHR definition is needed before the actual write up starts. Also mHealth is a term much more used than PHR.
  • Publications also use the term medication reconciliation aka the best possible medication history. These publications tend to link this term with PHR but not with medication adherence.
  • Would it be unadvised to assume that war veterans suffer from chronic conditions, without the authors explicitly state so?
  • Studies that used two modes of intervention are included if the primary mode is PHR-based.
  • A few publications use the term medication misuse, instead of medication adherence. I think it is safe to assume that if a patient does not misuse their medication they adhere to it.
  • Good adherence encompasses multiple dimensions, including intensity and timing of use according to prescription (compliance), continuous use (persistence) and correct use (technique). van Boven, J. F., Trappenburg, J. C., van der Molen, T., & Chavannes, N. H. (2015). Towards tailored and targeted adherence assessment to optimise asthma management. Npj Primary Care Respiratory Medicine, 25(1), 15046. https://doi.org/10.1038/npjpcrm.2015.46

Possible comparisons:

  1. What impact does PHR intervention have in medication adherence? (positive, negative, none)
  2. What impact does PHR intervention have in patient’s attitude towards starting a new medication?
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Thoughts on literature review screening process

The screening process finished and resulted in the inclusion of 130 articles.

The following statements are my personal opinions, thoughts and generalizations of what I have read in titles/abstracts/keywords so far.

  • Medication adherence and literacy is a hot topic
  • Medication adherence, literacy and technology is something that I have not encountered yet
  • A lot of research in mental health conditions
  • Way too few RTCs so far I identified 2 out of 200 for further reading
  • There is clear link on medication adherence and patient behavior changes
  • A lot of studies say “technological interventions” without specifying
  • I decided to include the studies that I am not too sure about
  • Way too few studies deal with comorbidities/polypharmacy ( found 3 so far)
  • A lot of studies separate people like black/whites or Latino and poor or rich and old/young/kids
  • Clear link between technology and self-management of a disease
  • Medication adherence and Asthma has a lot of papers
  • Instead of saying medication adherence, papers say behavior change in the way patients live or take their medication. Is it because they do not explore just adherence or is it because they do not like the term and the implications of it?
  • There is a lot of research in similar fields with us in China.
  • Pharmacotherapy: the treatment of disease through the administration of drugs.
  • There are a lot of PHR vendors in USA
  • Vast majority of the researches have 6 months to a year length
  • Again the researches do not focus on just medication adherence, but also patient’s other life aspects
  • At the papers that have abstracts from the xyz conference, meeting, whatever, I searched for the keywords “medication adherence”, PHR and “personal health record” in order to save time and not to read nice but utterly irrelevant abstracts

 

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