Digital Medicine System in Veterans With Severe Mental Illness: Feasibility and Acceptability Study

Authors

Sarah Gonzales
Olaoluwa O Okusaga
J Corey Reuteman-Fowler
Megan M Oakes
Jamie N Brown
Scott Moore
Allison A Lewinski
Cristin Rodriguez
Norma Moncayo
Valerie A Smith
Shauna Malone
Justine List
Raymond Y Cho
Amy S Jeffreys
Hayden B Bosworth

Language

English

Publication Date

12-22-2022

Journal

10.2196/34893

DOI

10.2196/34893

PMID

36548028

PMCID

PMC9816955

PubMedCentral® Posted Date

12-22-2022

PubMedCentral® Full Text Version

Post-print

Abstract

Background: Suboptimal 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.

Objective: The 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.

Methods: This 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.

Results: We 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.

Conclusions: There 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.

Keywords

ABILIFY MYCITE, Veterans, adherence, aripiprazole, digital medicine, medication, mental health, mental illness, mobile phone, qualitative methods

Comments

Trial registration: ClinicalTrials.gov NCT03881449;

Published Open-Access

yes

Recommended Citation

Gonzales, Sarah; Okusaga, Olaoluwa O; Reuteman-Fowler, J Corey; et al., "Digital Medicine System in Veterans With Severe Mental Illness: Feasibility and Acceptability Study" (2022). Staff and Researcher Publications. 17.
https://digitalcommons.library.tmc.edu/clinic_pub/17