Text messaging reminders for influenza vaccine in primary care: a cluster randomized controlled trial

As technology grows, innovations within the pharmaceutical fields also grow. A new trend in community pharmacies to incorporating technologies like handheld devices into maintaining healthcare is steadily expanding. A study was conducted to develop methods for conducting cluster randomized trials of text messaging interventions utilizing routine electronic health records at low cost and to assess the effectiveness of text messaging influenza vaccine reminders in increasing vaccine uptake in patients with chronic conditions. This study included 156 general practices who used text messaging software who had not previously used text messaging influenza vaccination reminders. Eligible patients of these practices were within 18-64 years old. 77 practices out of 156 were assigned to the intervention group (random) and 79 practices were assigned to the standard care group. The results found that text messaging increased absolute vaccine uptake by 2.62% (95% CI −0.09% to 5.33%).

This study found that text-messaging, a very low cost method, resulted in moderate improvements in influenza vaccine uptake. Although the changes were not drastic, it shows that implementation of these new intervention types could have a positive impact within the community setting. Hopefully, a better intervention method using technologies like this will grow in the future.

Herrett E., Williamson E., Staa T., et al. Text messaging reminders for influenza vaccine in primary care: a cluster randomized controlled trial. BMJ. 2016; 6

Persistence of metabolic monitoring for psychiatry inpatients treated with second-generation antipsychotics utilizing a computer-based intervention

This article goes over a novel technique to try and improve the quality of patient metabolic monitoring during the use of 2nd generation antipsychotics by using a computer interface and pop-up alert system. Patients taking 2nd generation psychotics can have side effects related to essential metabolic processes. These effects can include weight gain, diabetes occurrence, and others. Therefore the efficiency and rate at which metabolic parameters are important to prevention of further health problems. The metabolic parameters being measured were blood glucose levels, hemoglobin A1C, and a lipid panel, which were then compared to to the initial implementation.

The goal of the study was to determine if the computer system with pop-up alerts was a better option than conventional methods by measuring the rate of monitoring in an inpatient setting. A total of 129 patients (159 in the initial cohort) were monitored and the study was carried out over a period of 4 years. A comparison was done between the computerized physician order entry (CPOE) pop-up alert system and the conventional systems via long term chart reviews. Patient chart reviews were also used to determine if monitoring improved patient outcomes or alerted medical personnel to health risks.

The end result of the study is that the new computer pop-up alert system to did not significantly change monitoring rates. Although there were interventions from the psychiatry team as a result of the computerized system, which shows potential for the use of the system in the future.

We are learning about 2nd generation antipsychotics currently in POP.

How do you think techonology could be better implemented in this special patient population to improve outcomes?

Find this article here:

Lee J, Dalack GW, Casher MI, et al. Persistence of metabolic monitoring for psychiatry inpatients treated with second generation antipsychotics utilizing a computer-based intervention.            J Clin Pharm Ther. 2016 Feb 26. doi: 10.1111/jcpt.12368.

Patient Use of Email, Facebook, and Physician Websites to Communicate with Physicians

A national cross-sectional online survey was conducted to explore patient behavior and interest in using the Internet to contact physicians. The sample consisted of 4,510 CVS customers with an inclusion criteria of at least one chronic condition. Out of the 4,510 subjects sampled, 2,252 responded. This survey measured demographic and health information, patient use of email and Facebook to contact physicians, and patient interest in and use of Web-based tools for health. Out of the 2,252 respondents, 37% reported contacting their physician(s) via email within the last six months, whereas 18% contacted via Facebook. The study also found a negative association between older age and contact with physician via email (OR 0.57 [95 % CI 0.41–0.78]) or Facebook (OR 0.28 [0.17–0.45]). Some patients were found to be interested in using Web-based tools to fill prescriptions, track health, and access health information (37-57%), but very few were currently doing so (4-8%)

Although this study only measured patient contact with physicians, the findings still may apply to pharmacists. The article noted one important detail from its findings; the gap between patient interest for online communication and the opportunities that physicians currently provide. With more development and adoption of creating a secure Web messaging system, a solution could be found that addresses patient demand for quicker and more convenient contact. The research also notes a very important statistic; patient interest in using web-based tools to fill prescriptions and track health/health information and the amount of patients already doing so. This shows that there are currently no well developed and implemented way for patients to perform all of these tasks. Although community pharmacies are rolling out individual programs for these needs, there is no one global tool that is available to patients that often visit multiple community pharmacies.

Lee J., Choudhry N., Wu A., et al. Patient Use of Email, Facebook, and Physician Websites to Communicate with Physicians: A National Online Survey of Retail Pharmacy Users. J Gen Intern Med. 2016; 31: 45-51

Smartphone-Based Fluorescent Diagnostic System for Highly Pathogenic H5N1 Viruses

In this article, a collaborative research team from South Korea has developed a diagnostic system for use with smart phone technology that is able to identify viruses such as H5N1, or bird flu. The method for this identification being fluorescence excitation and analysis. All of which were smartphone battery powered. The complete setup includes as smartphone (galaxy S3 +others), an apparatus for the device, and samples on test strips.

In order to improve the optical quality of the smartphone features, an apparatus was created that held the phone in place in alignment with an LED light, excitation fiber, emission filter, and upper and lower reflector (parabolic mirrors). The apparatus had the smart phone facing downward to detect the fluorescence using an application in coordination with the diagnostic apparatus, which relayed information back to the phone. Test strips containing unidentified biological specimens would be placed underneath the phone.

Preliminary tests indicate that this method can be used with great accuracy. Of the 29 patients with H5N1, only 1 of them showed of false negative when subjected to smartphone analysis. This relates to pharmacy because potent viruses like H5N1 are public health concerns that could potentially warrant mass vaccinations. Vaccinations fall under the responsibility of a pharmacist, and we are often the most accessible healthcare professional when it comes to vaccinations on a large scale.

Do you think smartphone technology like this will become more prevalent in the future?

You can view the article here: Smartphone-Based Fluorescent Diagnostic System for Highly Pathogenic H5N1 Viruses.

Yeo S, Choi K, Cuc BT, et al. Smartphone-Based Fluoranalyzeescent Diagnostic System for Highly Pathogenic H5N1 Viruses. Theranostics. 2016 Jan 1;6(2):231-42

 

Mobile App Features Sought by Patients of Giant Eagle

This purpose of this study was to gain information about what features patients look for in a mobile application for pharmacy services provided by Giant Eagle pharmacies. Giant Eagle has 218 locations across western Pennsylvania, West Virginia, Ohio, Maryland and Indiana. At the time of the study, the company had a mobile app for grocery service and a pharmacy services app in development that had not yet been launched. Services provided by Giant Eagle pharmacists include providing medication therapy management (MTM), immunizations, counseling on specialty medications and diabetes self-management.

Participant interviews for the study took place at 5 different Giant Eagle pharmacies in Pittsburgh, PA. Eligible participants included patients older than 35 years old who use and own a smartphone on a daily basis. They also had to have received a prescription from the pharmacy on a monthly basis to be eligible. Participants were recruited to the study at the pharmacy counter when they dropped off or picked up prescriptions. Before the interview about preferred features in a mobile app, demographic information was collected. A total of 24 interviews were conducted with participants at the different locations. All participants interviewed stated a need for an app to be “user friendly,” meaning an app that requires few steps to reach a certain function. There were a few different themes for an app that participants desired. The first theme being an app meant to foster an improved and convenient pharmacy experience. The second theme described features designed to help patients with self-management of their medications. The third theme involves features to increase timely and personalized access to pharmacists.

This study showed that patients desire more information from a mobile app for convenience and ease of access. This could have a positive impact on the workflow for pharmacists. An app that provides patients with comprehensive services, medication lists, and drug and disease state information could reduce the frequency of patient calls for simple requests. By reducing the number of phone calls for simple requests such as drug identification questions or checking on checking if an order is ready, pharmacists would have more time to focus on patient care services like MTM. Patients expressed that they want an app that makes it easy to communicate to a pharmacists via instant messaging, video chat, or email. This could improve patient outcomes, as it has been demonstrated before that outcomes improve when pharmacists interact directly with patients. Overall, the study showed that patient desires should be considered when creating a mobile pharmacy app. This study could be helpful for community pharmacies across the country when they design mobile applications.

McCartney E, Bacci JL, Ossman KL, et al. Mobile application features sought after by patients of a regional grocery store chain pharmacy. J Am Pharm Assoc. 2016;56(1):62-66.

Patient perceptions of e-prescribing and its impact on their relationships with providers

In our health care system, prescription information can be electronically transferred from the prescriber to the pharmacist, causing an increase in efficiency and safety along with a decrease in cost. This allows for an improvement in the quality of patient care. This study focused on the perspective of the patients on electronic-prescribing. Its objective was to find the impact of these e-prescribing systems on quality of care, on patient-pharmacist interaction, and on engagement in health care. The study conducted interviews with 12 patients. The results found both positive and negative perceptions on the e-prescribing system.

The positive perceptions were related to an improvement in convenience, safety and quality, and cost. There were less medication errors, such as those caused by the illegibility of a prescriber’s handwriting. The negative perceptions were associated with communication challenges between pharmacists and prescribers, prescriptions being sent to the wrong pharmacy, and the patient feeling as if he or she less control over prescriptions. A common concern expressed by the patients was the lack of opportunity to talk with the community pharmacist during the prescription drop-off step. Patients viewed this step as a chance to learn more about their medication before deciding to have it filled. As well, it provided pharmacists with a chance to discuss nonadherence issues with patients. Another concern was that, oftentimes, a patient would have no knowledge about their prescription, such as drug name or dosage, until reaching the pharmacy.

I found this study very interesting because it looked at the patients’ viewpoints on the use of technology in our health care system. Technology should not only benefit the health care providers, but it should also benefit the patients. Therefore, it is important to understand where patients stand on these issues. This study that was conducted may have allowed researchers to realize that e-prescribing may be decreasing opportunities for a patient-pharmacist relationship to develop. With knowledge about this information, pharmacists may want to put in extra effort to talk with their patients when they are picking up prescriptions to ensure that the patients are fully informed about the medications that they are taking. Being able to develop a relationship with patients is an important aspect of delivering high-quality patient care.

Frail CK, Kline M, Snyder ME. Patient perceptions of e-prescribing and its impact on their relationships with providers: A qualitative analysis. J Am Pharm Assoc. 2014;54:630-33

http://www.japha.org/article/S1544-3191(15)30262-4/fulltext

Machine Learning and the Profession of Medicine

This article asks the question must the physician( or any medical professional for that matter) be human? The Institute for Creative Technologies developed a new computer they named “Ellie” that is able to analyze patient facial expressions and vocal tones, intonations and responses. Through this analysis it was even able to detect signs of PTSD. In the study, a group of 239 patients were told that “Ellie” was either controlled by a person or operating autonomously. It was actually found that the latter option produced more personal and intimate responses to the computer program.

The article then talks about how technology needs to continue to develop within the walls of technology. It discusses how the electronic medical record is just starting to be embraced but this should for no reason be the end of what they refer to as a “digital revolution.” It is believed that technology has tremendous potential and practical implementation in the practice of patient care.

How do you feel about the use of technology as a means to patient care? Does it make the medical professional obsolete and no longer necessary? Why have a human surgeon when you can have a computer operate on you? How will this kind of technology impact the field of pharmacy? Why will their still be a need for pharmacists if a computer can provide MTM services to patients? Will patients trust a computer to provide information to them….what about in subsequent generations?

Citation:

Darcy AM, Louie AK, Roberts L. Machine Learning and the Profession of Medicine.JAMA. 2016;315(6):551-552. doi:10.1001/jama.2015.18421.