Patient Perspectives on Short-Course Pharmacotherapy: Barriers and Facilitators to Medication Adherence

Medication nonadherence is a public health issue that contributes to poor health outcomes and health-care costs. Factors influencing long-term medication adherence are known; however, little is known about short-course medication adherence.

This study examined patient perspectives on adherence and factors that influence adherence to short-course pharmacotherapy in diarrhea-predominant irritable bowel syndrome.

Twenty-seven participants were interviewed to identify their perceptions of barriers and facilitators to thrice-daily, 14-day rifaximin.

Participants were primarily female (89%), aged 18 to 65 years. Sixty-eight percent of interviewees were identified as “low-adherers,” meaning the percentage of days with correct daily dosing of rifaximin was <80%. The final coding framework identified social/economic-related (family support and medication expense), system-related (relationship with provider and medication knowledge), condition-related (symptom severity), therapy-related (inconvenient dosing), and patient-related (forgetfulness and busyness of daily life) factors that influenced adherence.

The resulting patient perspectives highlight a diverse set of factors that influence short-course adherence and the need for tailored interventions that address these various factors resulting in enhanced patient outcomes.

The full article can be downloaded below.  

Building a Secure Biomedical Data Sharing Decentralized App: Tutorial

Decentralized apps (DApps) are computer programs that run on a distributed computing system, such as a blockchain network. Unlike the client-server architecture that powers most internet apps, DApps that are integrated with a blockchain network can execute app logic that is guaranteed to be transparent, verifiable, and immutable. This new paradigm has a number of unique properties that are attractive to the biomedical and health care communities. However, instructional resources are scarcely available for biomedical software developers to begin building DApps on a blockchain. Such apps require new ways of thinking about how to build, maintain, and deploy software. This tutorial serves as a complete working prototype of a DApp, motivated by a real use case in biomedical research requiring data privacy. We describe the architecture of a DApp, the implementation details of a smart contract, a sample iPhone operating system (iOS) DApp that interacts with the smart contract, and the development tools and libraries necessary to get started. The code necessary to recreate the app is publicly available.

The full article can be downloaded below.  

Urbanization Leaves Rural America In A Health Care Crisis

Declining birth rates and an aging population have impacted American migration patterns for decades. But according to the USDA’s Economic Research Service, between 2010 and 2017, almost 1,000 rural counties in the U.S. recorded more deaths than births. Add in migration patterns of people moving from rural areas of the country to more urban and suburban regions, and we find that in 2019 only 20% of Americans live in rural areas - which accounts for a surprising 97% of U.S. land mass.

But the implications of these population shifts greatly exceed the economic and housing needs of the region. Population change also means significant changes in health care need, demand and access. According to the National Institute for Health Care Management (NIHCM), “As urbanization increases, an older, sicker and poorer population remains in rural America.” What this really means is that those Americans living in rural areas of the country have much greater health issues, and far fewer health resources.

The full Forbes article can be found at this link.  

The Use of Telehealth in School-Based Health Centers

Telehealth is a growing model of delivering health care. School-based health centers (SBHCs) provide access to health care for youth in schools and increasingly use telehealth in care delivery. This article examines the recent growth of telehealth use in SBHCs, and characteristics of SBHCs using telehealth, including provider types, operational characteristics, and schools and students served. The percentage of SBHCs using telehealth grew from 7% in 2007-2008 to 19% in 2016-2017. Over 1 million students in over 1800 public schools have access to an SBHC using telehealth, which represents 2% of students and nearly 2% of public schools in the United States. These SBHCs are primarily in rural communities and sponsored by hospitals. This growing model presents an opportunity to expand health care access to youth, particularly in underserved areas in the United States and globally. Further research is needed to fully describe how telehealth programs are implemented in school settings and their potential impacts.

The full article can be downloaded below.  

Dissecting racial bias in an algorithm used to manage the health of populations

Health systems rely on commercial prediction algorithms to identify and help patients with complex health needs. We show that a widely used algorithm, typical of this industry-wide approach and affecting millions of patients, exhibits significant racial bias: At a given risk score, Black patients are considerably sicker than White patients, as evidenced by signs of uncontrolled illnesses. Remedying this disparity would increase the percentage of Black patients receiving additional help from 17.7 to 46.5%. The bias arises because the algorithm predicts health care costs rather than illness, but unequal access to care means that we spend less money caring for Black patients than for White patients. Thus, despite health care cost appearing to be an effective proxy for health by some measures of predictive accuracy, large racial biases arise. We suggest that the choice of convenient, seemingly effective proxies for ground truth can be an important source of algorithmic bias in many contexts.

The full article can be downloaded below.  

An integrated web application for decision support and automation of EHR workflow: a case study of current challenges to standards-based messaging and scalability from the EMBED trial

Computerized clinical decision support (CDS) faces challenges to interoperability and scalability. Centralized, web-based solutions offer a mechanism to share the cost of CDS development, maintenance, and implementation across practices. Data standards have emerged to facilitate interoperability and rapid integration of such third-party CDS. This case report describes the challenges to implementation and scalability of an integrated, web-based CDS intervention for EMergency department-initiated BuprenorphinE for opioid use Disorder which will soon be evaluated in a trial across 20 sites in five healthcare systems. Due to limitations of current standards, security concerns, and the need for resource-intensive local customization, barriers persist related to centralized CDS at this scale. These challenges demonstrate the need and importance for future standards to support two-way messaging (read and write) between electronic health records and web applications, thus allowing for more robust sharing across health systems and decreasing redundant, resource-intensive CDS development at individual sites.

The full case report can be downloaded below.  

Data and insights platforms are helping healthcare stakeholders manage large volumes of data amongst and between systems, while connecting members of a care team, including the actual patient. The insights gleaned from data and analytics is proving invaluable, and healthcare stakeholders need systems that offer a smooth pathway toward sustainability. Data will continue to be the most valuable asset in managing current and future business models. As organizations grapple with ways to manage the huge volumes of data collected across the healthcare industry, these platforms are helping to create data-centric strategies focused on managing both the entire lifecycle of data and longitudinal, whole person care for any circumstance that could affect health. Data and insights platforms are the waves of the future. Read our report to hear industry perspectives on platforms.

A Health Information System That Puts People First

Healthcare providers that prioritize cost control over innovative care do their patients—and the people that work for them—a serious disservice. Investing in technology that augments patient centered solutions not only turns a profit, but more importantly gives struggling health systems the data, tools, and collective understanding needed to improve human health.

That is precisely what happened at NYU Langone Health, where a comprehensive, real time information system fuels a robust culture of accountability. By inspiring staff to reexamine how and why they work, the system helps the academic medical center drive down costs, elevate safety and quality standards, and above all achieve better patient outcomes.

The full Forbes article can be viewed at this link.  

Capturing the patient voice: implementing patient‑reported outcomes across the health system

Supporting the capture and use of patient-reported outcomes (PROs) at the point-of-care enriches information about important clinical and quality of life outcomes. Yet the ability to scale PROs across healthcare systems has been limited by knowledge gaps around how to manage the diversity of PRO uses and leverage health information technology. In this study, we report learnings and practice insights from UW Medicine’s practice transformation efforts to incorporate patient voice into multiple areas of care.

Using a participatory, action research approach, we engaged with UW Medicine clinical and administrative stakeholders experienced with PRO implementation to inventory PRO implementations across the health system, characterize common clinical uses for PROs, and develop recommendations for system-wide governance and implementation of PROs.

We identified a wide breadth of PRO implementations (n=14) in practice and found that nearly half (47%) of employed PRO measures captured shared clinical domains (e.g., depression). We developed three vignettes (use cases) that illustrate how users interact with PROs, characterize common ways PRO implementations support clinical care across the health system (1) Preventive care, (2) Chronic/Specialty care, and (3) Surgical/Interventional care), and elucidate opportunities to enhance efficient PRO implementations through system-level standards and governance.

Practice transformation efforts increasingly require integration of the patient voice into clinical care, often through the use of PROs. Learnings from our work highlight the importance of proactively considering how PROs will be used across the layers of healthcare organizations to optimize the design and governance of PROs.

The full article can be downloaded below.  

The use or generation of biomedical data and existing medicines to discover and establish new treatments for patients with rare diseases – recommendations of the IRDiRC Data Mining and Repurposing Task Force

The number of available therapies for rare diseases remains low, as fewer than 6% of rare diseases have an approved treatment option. The International Rare Diseases Research Consortium (IRDiRC) set up the multistakeholder Data Mining and Repurposing (DMR) Task Force to examine the potential of applying biomedical data mining strategies to identify new opportunities to use existing pharmaceutical compounds in new ways and to accelerate the pace of drug development for rare disease patients. In reviewing past successes of data mining for drug repurposing, and planning for future biomedical research capacity, the DMR Task Force identified four strategic infrastructure investment areas to focus on in order to accelerate rare disease research productivity and drug development: (1) improving the capture and sharing of self-reported patient data, (2) better integration of existing research data, (3) increasing experimental testing capacity, and (4) sharing of rare disease research and development expertise. Additionally, the DMR Task Force also recommended a number of strategies to increase data mining and repurposing opportunities for rare diseases research as well as the development of individualized and precision medicine strategies.

The full article can be downloaded below.