My MediHealth: A Paradigm for Children-Centered Medication Management (Tennessee)

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Summary:

Medication management of children with chronic conditions is complex because of the need to tailor dosages to a child’s age, weight, and development, and because of the likelihood that such children have multiple caregivers. This project addressed medication management in the pediatric population—particularly children with asthma—through further development of MyMediHealth (MMH). MMH is a mobile personal health application for medication management that was built to interface and share information with personal health records (PHRs). The overarching goal of this project was to use text messaging reminders to assess the impact of personal medication management tools on medication adherence in adolescents with asthma.

The specific aims of this project were to:

  • Develop an information and scheduling knowledge base for common pediatric asthma medications (including allergy medications). 
  • Adapt MyMediHealth in its current prototype form to patients diagnosed with asthma. 
  • Integrate MyMediHealth into the Vanderbilt patient portal to support medication scheduling and the creation of medication reminders. 
  • Evaluate the impact of MyMediHealth on medication adherence.

Ninety-eight children and their parents were randomized to receive either access to the MMH Web site or standard therapy and education. The Web site allowed users to create medication schedules and generate text message reminders about their medications. At baseline and 3 weeks, each group was assessed for symptom frequency, rescue inhaler use, and self-reported medication adherence. In addition, a sample of families in the intervention group received a home visit by a member of the project team to assess the home environment, allowing for a more in-depth understanding of barriers to medication adherence and intended use of the MMH.

At baseline, there were no significant differences between the two groups. Of those in the intervention group, 87 percent signed into MMH, but only half showed any activity on the site. Twenty-four of 46 participants in the intervention group exchanged at least one text message recorded in the system usage log (“users”). A significant improvement in the intervention group’s medication adherence was observed, although no change in asthma control was noted between the two groups. Quality-of-life and self-efficacy measures showed mild improvement in the intervention group.

Initially, the project team planned to integrate MMH into the Vanderbilt patient portal. However, security concerns from the risk management team at the university prevented this integration from taking place during the project period. MMH was therefore developed to have the ability to interface with any PHR, not specifically to the Vanderbilt system.

The project showed that use of PHR-based and text messaging tools can promote improved asthma medication management in adolescents by integrating a simple reminder system into daily routines. These systems have the potential to support a variety of individuals varying in age and chronic illness, and can be extended for use into tools beyond medication adherence.

MyMediHealth: A Paradigm for Children-Centered Medication Management - 2012

Summary Highlights

  • Principal Investigator: 
  • Organization: 
  • Funding Mechanism: 
    PAR: HS08-270: Utilizing Health Information Technology to Improve Health Care Quality Grant (R18)
  • Grant Number: 
    R18 HS 018168
  • Project Period: 
    December 2009 – July 2013
  • AHRQ Funding Amount: 
    $1,200,000
  • PDF Version: 
    (PDF, 268.43 KB)

Summary: Medication management of children with chronic conditions is complex because of the need to tailor dosages based on a child’s age, weight, and development, and because of the likelihood that such children have multiple caregivers. A team at Vanderbilt University Medical Center in Tennessee is addressing medication management in the pediatric population through further development of MyMediHealth, a mobile personal health application for medication management that is built to interface and share information with a personal health record (PHR). The overarching goal of this project is to investigate ways that PHRs and supported applications might improve the safety and quality of medication delivery.

The study is evaluating the impact of the MyMediHealth application on medication adherence in children ages 12-to-18 who have asthma and are patients at the Vanderbilt Primary Care Clinic. The control group received education on asthma management, while the intervention group received education and training about asthma management and the use of MyMediHealth. The application provides medication information and reminders to children by cell phone. Patients are able to create medication schedules, schedule alerts to mobile devices, and examine medication administration information.

The project team developed a knowledge base of common pediatric asthma medications that have been incorporated into MyMediHealth and are part of the evaluation of the application on medication adherence. The study measures also include effect on family dynamics, disease control, and impact on caregivers outside the home, such as school caregivers and health care providers.

Specific Aims:

  • Develop an information and scheduling knowledge base for common pediatric asthma medications (including allergy medications). (Achieved)
  • Adapt MyMediHealth in its current prototype form to patients diagnosed with asthma.(Achieved)
  • Evaluate the impact of MyMediHealth on medication adherence. (Achieved)

2012 Activities: The evaluation of MyMediHealth was completed in 2012. This included evaluation of medication adherence using ecological momentary assessment, which uses cell phones and other electronic devices to capture dosing at the time of the event. The research team recruited 50 children for the intervention and 50 children for the control. Both groups received information on asthma management and the intervention group also received information on MyMediHealth so that the group could receive
reminder messages via cell phone for asthma medication dosing. The MyMediHealth Web site allows families to enter information on a child’s asthma dosing regimen and includes a place to input the child’s asthma action plan. The families can also use the Web site for data tracking after they have begun using the application.

The team completed home visits with 20 percent of the users to further understand their daily environment. This provided more in-depth understanding of barriers to medication adherence and barriers to the intended use of the MyMediHealth tool. In terms of tool use, the team looked at both user testing of the site to identify any problems from the user perspective, and assessed how the home environment might have supported or created barriers to using the tool. Both parent and child were included in the assessment as the tool was used by the family initially, and then by the child independently.

The research team is using a 1-year no-cost extension to complete data analysis from the qualitative interviews done during the home visits and to complete three planned publications. As last self-reported in the AHRQ Research Reporting System, project progress and activities are mostly on track and project spending is roughly on target.

Preliminary Impact and Findings: An important finding of the project is how people use reminders. The project team initially planned to pilot the medication reminders for 9 months, but after only 2 weeks had a good understanding of usage of the reminder system.

A second finding is that there is quite a bit of cost associated with bi-directional texting to confirm compliance with medications. This is especially true if a patient is taking four-to-five medications. Some of the study participants have unlimited texting plans and others do not. Despite the potential cost, the project team decided not to make unlimited texting a requirement for inclusion in the evaluation.

The team also learned about some cell phone carrier-dependent technical challenges to transmitting messages. For example, the research team found that depending on the mobile carrier, reminder messages sent out through the mobile device might be delayed as many as 24 hours. The team also found that the “unsubscribe” function on cell phone lists might inadvertently cancel medication reminders, when the intent was to unsubscribe from a different non-health related list, such as updates from a musical artist.

Target Population: Asthma, Chronic Care*, Medicaid, Pediatric*, Teenagers

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to improve the quality and safety of medication management via the integration and utilization of medication management systems and technologies.

Business Goal: Knowledge Creation

* This target population is one of AHRQ’s priority populations.

My MediHealth: A Paradigm for Children-Centered Medication Management - 2011

Summary Highlights

  • Principal Investigator: 
  • Organization: 
  • Funding Mechanism: 
    PAR: HS08-270: Utilizing Health Information Technology to Improve Health Care Quality Grant (R18)
  • Grant Number: 
    R18 HS 018168
  • Project Period: 
    December 2009 - November 2012
  • AHRQ Funding Amount: 
    $1,200,000
  • PDF Version: 
    (PDF, 199.2 KB)

Summary: Medication management of children with chronic conditions is complex because of the need to tailor dosages based on a child's age and development, and because of the likelihood that such children have multiple caregivers. To improve care of children with chronic disease, a team at Vanderbilt University Medical Center in Tennessee, led by Dr. Kevin Johnson, is working to address medication management in the pediatric population through further development of MyMediHealth, a mobile personal health application for medication management that is built to interface and share information with a personal health record (PHR). The overarching goal of this project is to investigate ways in which PHRs and supported applications can improve the safety and quality of medication delivery.

The study is evaluating the impact of the MyMediHealth application on medication adherence in children ages 12-to-18 who have asthma and are patients at the Vanderbilt Primary Care Clinic. The control group is receiving education on asthma management, while the intervention group is receiving education and training about asthma management and the use of MyMediHealth. The application provides medication information and reminders to children by cell phone. Patients are able to create medication schedules, schedule alerts to mobile devices, and examine medication administration information. The PHR provides laboratory results, relevant medical literature, email for direct communication with providers, and direct appointment scheduling.

The project team developed a knowledge base of common pediatric asthma medications that have been incorporated into MyMediHealth and will be part of the evaluation of the application on medication adherence. In addition to medication adherence, study measures include effect on family dynamics, disease control, and impact on caregivers outside the home, such as school caregivers and health care providers. The results of this study will have important implications for understanding how to further patient-centered care and medication adherence in the pediatric population. Some findings may also be applicable to chronic disease management in the adult population.

Specific Aims:

  • Develop an information and scheduling knowledge base for common pediatric asthma medications (including allergy medications). (Achieved)
  • Adapt MyMediHealth in its current prototype form to patients diagnosed with asthma. (Achieved)
  • Integrate MyMediHealth into the Vanderbilt patient portal to support medication scheduling and the creation of medication reminders. (Unlikely to achieve)
  • Evaluate the impact of MyMediHealth on medication adherence. (Ongoing)

2011 Activities: Due to security concerns from the risk management team at the University, Dr. Johnson was unable to have MyMediHealth integrated into Vanderbilt's PHR, "My Health at Vanderbilt". The risk management team felt that further research is needed to understand and protect patient data before the interface between these tools can be made available. As a result, the project team has developed MyMediHealth with the ability to interface with any PHR and thus it is not tailored to work specifically with My Health at Vanderbilt.

The project team completed the adaptions and modifications to MyMediHealth and plans to begin the evaluation in January 2012. In the last quarter of 2011, the project team developed and finalized the evaluation tools. The team has developed all of their measures for the evaluation and will be submitting the final protocol to their institutional review board.

All patient enrollment will be done by phone. The enrollment tools are currently being pilot tested. The evaluation will begin with the English-speaking patients; thereafter the team will begin translating the tools to Spanish. The MyMediHealth Web site has been undergoing testing using a "think aloud methodology" with community engagement groups established on the Vanderbilt campus. The Web site is where families will enter information on the child's asthma dosing regimen, and it includes a place to input the child's asthma action plan. The families can also use the Web site for data tracking after they have begun using the application.

As last self-reported in the AHRQ Research Reporting System, project progress and activities are on track and project spending is on target.

Preliminary Impact and Findings: An important finding of the project is how people use reminders. The project team initially planned to pilot the medication reminders for 9 months, but have obtained a good understanding of usage of the reminder system in a much shorter period of time (2 weeks).

A second finding is that there is quite a bit of cost associated with bi-directional texting to confirm compliance with medications. This is especially true if a patient is taking four-to-five medications. Some of the study participants have unlimited texting plans, and others do not. Despite the potential cost, the project team decided not to make unlimited texting a requirement for inclusion in the evaluation.

Target Population: Asthma, Chronic Care*, Medicaid, Pediatric*, Teenagers

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to improve the quality and safety of medication management via the integration and utilization of medication management systems and technologies.

Business Goal: Knowledge Creation

* This target population is one of AHRQ's priority populations.

My MediHealth: A Paradigm for Children-Centered Medication Management - 2010

Summary Highlights

  • Principal Investigator: 
  • Organization: 
  • Funding Mechanism: 
    PAR: HS08-270: Utilizing Health Information Technology to Improve Health Care Quality Grant (R18)
  • Grant Number: 
    R18 HS 018168
  • Project Period: 
    December 2009 – November 2012
  • AHRQ Funding Amount: 
    $1,200,000
  • PDF Version: 
    (PDF, 395.41 KB)


Target Population: Asthma, Chronic Care*, Medicaid, Pediatric*, Teenagers

Summary: Medication management of children with chronic conditions is complex because of the need to tailor dosages based on a child’s age and development, and because of the potential for frequent handoffs between caregivers. To improve care of children with chronic disease, a team at Vanderbilt University Medical Center in Tennessee, led by Dr. Kevin Johnson, is working to address medication management in the pediatric population through further development of MyMediHealth, a mobile personal health application specifically for medication management which is built to interface and share information with a personal health record (PHR). The overarching goal of the MyMediHealth project is to investigate ways in which personal health records and supported applications can improve the safety and quality of medication delivery.

The study will evaluate the impact of use of MyMediHealth on medication adherence in children ages 12 to 18 with asthma in the Vanderbilt Primary Care Clinic. The control group will receive education about the personal health record (PHR) only, while the intervention group will receive education and training about the use of the PHR and MyMediHealth. MyMediHealth will provide medication information and reminders to children by cell phone or pager, with additional support from a Web-based patient portal (access controlled by parent). Patients will be able to create medication schedules, schedule alerts to mobile devices, and examine medication administration information. The patient portal will provide laboratory results, relevant medical literature, e-mail for direct communication with providers, and direct appointment scheduling.

The project will develop a knowledgebase of common pediatric asthma medications that will be incorporated into MyMediHealth to evaluate the impact of MyMediHealth on medication adherence. Study measures include medication adherence, effect on family dynamics, disease control, and impact on caregivers outside the home (i.e., school caregivers and health care providers). The results of this study will have important implications for understanding how to further patient-centered care and medication adherence in the pediatric population. Some findings may also be applicable to chronic disease management in the adult population.

Specific Aims:
  • Develop an information and scheduling knowledgebase for common pediatric asthma medications (including allergy medications). (Achieved)
  • Adapt MyMediHealth in its current prototype form to patients diagnosed with asthma. (Ongoing)
  • Integrate MyMediHealth into the Vanderbilt patient portal to support medication scheduling and the creation of medication reminders.(Unlikely to achieve)
  • Evaluate the impact of MyMediHealth on medication adherence. (Ongoing)

2010 Activities: In 2010, the team completed the asthma medications knowledgebase, and nearly completed the adaptation of the MyMediHealth prototype. The remaining work on the prototype involves making small modifications and refinements. For example, the team is adding photos of medications to the database, as well as functionality for users to add photos of their own. In addition, they are adapting MyMediHealth for Spanish speakers and have continued to work on improving the user interface. On the technical side, they have been developing the natural language processing to enable an automatic categorization of text responses from patients. The project team also met with the senior management at Vanderbilt about the interface between MyMediHealth and the MyHealthAtVanderbilt PHR. Due to privacy and information-sharing concerns, the tool will not directly interface with MyHealthAtVanderbilt at this time; therefore the third project aim is unlikely to be achieved. However, it will interface with other Web-based PHRs such as Google Health.

MyMediHealth was shared with a patient advocacy group at one hospital, and the team has plans to share it with the children’s hospital in spring 2011. MyMediHealth was also shared with the Teen-Medi group which includes teenagers, providers, and others (school nurses, teachers, etc.). The teenagers use the tool for two weeks before the meetings to gain firsthand knowledge. They then share the ways they used MyMediHealth and their thoughts about it as a tool to manage health. The initial anecdotal feedback so far has been positive.

The evaluation of MyMediHealth began in 2010, and the team was successful in reaching the goal of recruiting 50 participants for the Ecological Momentary Assessment (EMA) Tool. The EMA Tool consists of an oral interview and a Web-based survey that asks about daily behaviors, regular dosing time, why that time is chosen, and any variation in dosing time. The EMA assessment is paired with tracking medication adherence using the MyMediHealth tool. Participants use the tracking tool embedded within MyMediHealth to measure when they use their inhalers over a 30-day period and then take an exit online survey. The tracking tool both reminds patients to take their medication and tracks patient responses to these reminders.

Grantee's Most Recent Self-Reported Quarterly Status (as of December 2010): Project progress is mostly on track. The team is meeting about 80 to 99 percent of the milestones and activities are generally on time. Budget funds are somewhat underspent, mainly due to the fact the project had a later start date, thus spending is on target relative to activities completed at this time.

Preliminary Impact and Findings: The project does not have any findings to date.

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to improve the quality and safety of medication management via the integration and utilization of medication management systems and technologies.

Business Goal: Knowledge Creation

*AHRQ Priority Population.

My MediHealth: A Paradigm for Children-Centered Medication Management - Final Report

Citation:
Johnson K. My MediHealth: A Paradigm for Children-Centered Medication Management - Final Report. (Prepared by Vanderbilt University under Grant No. R18 HS018168). Rockville, MD: Agency for Healthcare Research and Quality, 2013. (PDF, 438.39 KB)

The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
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