Kidney Disease Patients Use App To Test Med Adherence

Patients with chronic kidney disease (CKD) who used a mobile device had a very low error rate when inputting medication information, according to a small study checking usability.

Researchers wanted to determine if mobile technology could help prevent improperly dosed or dangerous medication decisions; they tested twenty predialysis patients, gave them a mobile flip-phone or an iPod Touch and trained them how to use it, and sent them three randomized sample bottles of pills. The patients were asked to enter the medication information into a medication inquiry system app, which then told the patient if the medication was safe or unsafe in CKD or if the patient should speak with their doctor before taking the medication. The patient then recorded the information in a journal.

Of 60 inquiries, there were three (5%) errors recorded by the patients, according to Clarissa Diamantidis, MD, at Duke University of School of Medicine, and the co-authors of the study. They published their results on Wednesday in the Clinical Journal of the American Society of Nephrology.

"The use of patient-centered technology and commonly accessed communication methods in a home setting addressing medication safety is significant," wrote Bryan Becker, MD, at the University of Chicago, in an accompanying editorial. "Injuries related to medication use or medication errors are common, clinically significant, and often very expensive."

He added that there are significant limitations to the study, including that it was not powered, didn't have a set of defined clinical outcomes, and was not randomized. But he said that usability studies are still very useful.

"This type of study is actually very important," he wrote. "It sits at the intersection of implementation science and the pragmatic acceptance of contemporary culture that inserts itself into our practice on a regular basis."

In the study, chronic kidney disease was defined as two eGFR measurements of <60 mL/min per 1.73m² at least 90 days apart. The patients were a part of the Safe Kidney Care Cohort Study, which is ongoing. Patients were excluded if they were expected to get end stage renal disease or die within one year of enrolling. All of the patients were given an eHealth Literacy Scale test, which measured their knowledge and skills, and ability to find and evaluate electronic health information.

Two of the errors occurred with the flip-phones, for which SMS texts were used.

"With both devices, the small number of errors was with those medications where there are no renal specifications to dosing," wrote the authors. The two errors were recorded by the same participant, who had a grade 6 or less education and no prior Internet use.

After the study, the patients returned the devices, filled out a satisfaction survey, and received $50. Patients reported being satisfied overall, and 75% reported that the Internet is useful in helping them make healthcare decisions.

There are several mobile applications available for addressing problems around medication adherence, but Becker noted that there haven't been very many studies examining these. Some studies have found that mobile health applications can enhance diabetes self-management, for example, but the limited evidence indicates that this had no effect on clinical measures like hemoglobin A1c and blood pressure.

"Technology use carries with it additional considerations. Personal digital assistants and most smartphones have small screen sizes and variable data entry options, bandwidth, and memory," wrote Becker. "In this context, the study by Diamantidis et al was straightforward and also, somewhat minimalistic."

Becker added that the study was well done, but that the pace of technological development makes this study both "positive and obsolete at the same time."

The authors said that new strategies that take advantage of existing technology should be studied. "Novel strategies are needed to promote patient engagement and self-directed patient safety among the high-risk population with CKD," they wrote.

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