David G. Schwartz , Sivan Spitzer , Michael Khalemsky , Arturo Heyner Cano-Bejar , Soumya Ray , Jeng-Yuan Chiou , Rizan Sakhnini , Raya Lanin , Menachem M. Meir , Ming-Che Tsai
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This study proposes and analyses potential frameworks for clinician-patient dialogue about DTx adherence.</p></div><div><h3>Methods</h3><p>Purposive sampling is used to select three leading adherence frameworks, one at each of the micro (patient), mesa (physician), and macro (system) levels of healthcare. The ABC taxonomy of adherence stages; Osterberg and Blaschke's medication adherence framework; and the Morisky Medication Adherence Scale-8 (MMAS8). Each framework is deconstructed and analysed from the perspective of DTx adherence.</p></div><div><h3>Results</h3><p>Modifications to ABC can improve suitability to conceptualize DTx adherence whilst maintaining the overall framework. Osterberg and Blaschke's framework provides many metrics adaptable to app assessment alongside some that are inapplicable. Significant modification of MMAS-8 appears necessary to build relevance to DTx adherence reporting. Specific reconceptualizations of each framework element are presented.</p></div><div><h3>Conclusions</h3><p>A strong basis for studying and measuring DTx adherence exists in existing treatment adherence research and practice, and can help guide policy. However, important adaptations are needed to ensure the development of methods for use in clinical environments.</p></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"13 2","pages":"Article 100848"},"PeriodicalIF":3.4000,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Apps don't work for patients who don't use them: Towards frameworks for digital therapeutics adherence\",\"authors\":\"David G. Schwartz , Sivan Spitzer , Michael Khalemsky , Arturo Heyner Cano-Bejar , Soumya Ray , Jeng-Yuan Chiou , Rizan Sakhnini , Raya Lanin , Menachem M. 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Apps don't work for patients who don't use them: Towards frameworks for digital therapeutics adherence
Objectives
Digital therapeutics such as mobile health applications (mHealth apps) are becoming part of patients’ treatment programs. Ensuring patients actually use (adhere to) an app as prescribed, effectively measuring and interpreting usage, and detecting clinical non-compliance are fundamental to effective treatment. Clinicians are not currently prepared to deal with issues of patients’ adherence to digital therapeutics (DTx). This study proposes and analyses potential frameworks for clinician-patient dialogue about DTx adherence.
Methods
Purposive sampling is used to select three leading adherence frameworks, one at each of the micro (patient), mesa (physician), and macro (system) levels of healthcare. The ABC taxonomy of adherence stages; Osterberg and Blaschke's medication adherence framework; and the Morisky Medication Adherence Scale-8 (MMAS8). Each framework is deconstructed and analysed from the perspective of DTx adherence.
Results
Modifications to ABC can improve suitability to conceptualize DTx adherence whilst maintaining the overall framework. Osterberg and Blaschke's framework provides many metrics adaptable to app assessment alongside some that are inapplicable. Significant modification of MMAS-8 appears necessary to build relevance to DTx adherence reporting. Specific reconceptualizations of each framework element are presented.
Conclusions
A strong basis for studying and measuring DTx adherence exists in existing treatment adherence research and practice, and can help guide policy. However, important adaptations are needed to ensure the development of methods for use in clinical environments.
期刊介绍：
Health Policy and Technology (HPT), is the official journal of the Fellowship of Postgraduate Medicine (FPM), a cross-disciplinary journal, which focuses on past, present and future health policy and the role of technology in clinical and non-clinical national and international health environments.
HPT provides a further excellent way for the FPM to continue to make important national and international contributions to development of policy and practice within medicine and related disciplines. The aim of HPT is to publish relevant, timely and accessible articles and commentaries to support policy-makers, health professionals, health technology providers, patient groups and academia interested in health policy and technology.
Topics covered by HPT will include:
- Health technology, including drug discovery, diagnostics, medicines, devices, therapeutic delivery and eHealth systems
- Cross-national comparisons on health policy using evidence-based approaches
- National studies on health policy to determine the outcomes of technology-driven initiatives
- Cross-border eHealth including health tourism
- The digital divide in mobility, access and affordability of healthcare
- Health technology assessment (HTA) methods and tools for evaluating the effectiveness of clinical and non-clinical health technologies
- Health and eHealth indicators and benchmarks (measure/metrics) for understanding the adoption and diffusion of health technologies
- Health and eHealth models and frameworks to support policy-makers and other stakeholders in decision-making
- Stakeholder engagement with health technologies (clinical and patient/citizen buy-in)
- Regulation and health economics
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