Patients typically view their problem as having depression and not as having a problem with medication adherence. There were no adverse events. MedLink Design MedLink is intended to support the care of patients initiating a new prescription for an antidepressant, as non-adherence usually occurs in the first weeks after a new prescription. Thus, this system sometimes launched reminders when the person had already taken their medication, resulting in confusion for some people. Several participants did not like the use of tray notifications and pop-ups as a means of providing reminders, although this was acceptable and useful to others. J Clin Pharm Ther.
Effective doses often are 2—3 times the minimal clinical dosage at which treatment is usually initiated. Similar results of practice variability were found in a more recent survey of 68 hospitals in the United States Shappell et al The EMR revealed a range of 0—5 for all follow-up encounters per participant with 10 having at least one encounter. Three participants used their own phones, while 5 were provided study phones; of those 5, one had an Android phone but no data plan, one had an Android phone that was too old, two had an iOS phone, and one had no smartphone. We review here some of the specific lessons learned, as well as a broader set of issues raised by this work.
Multimodal e-mental health treatment for depression: Lessons written by authors D. We elected to retain the treatment recommendation, given physician failure to optimize dose is a common failure point, and because treatment recommendations are a common part of current practice in American general medicine clinics.
Am J Manag Care.
Other systemic issues that we considered were related to privacy concerns, such as receiving reminders in public. Mark of the University of Alabama at Birmingham has no relevant financial relationships reaearch disclose. The influence of antidepressant concerns and treatment preferences. Contact information for both the prescribing physician and study research assistant was viewable under contacts.
Outcomes are poor due to failure points across the care system, including patient non-adherence, failure of physicians to optimize the treatment regimens, and lack of patient-physician communication.
MedLink is a behavioral intervention technology 30 digital support system intended to enhance antidepressant treatment processes and outcomes in primary care, targeting the failure points described in Figure 1. Wisepill pill box Wisepill is an electronic pill dispenser that is cellularly enabled so that a signal is sent over the cellular network in real time, informing the MedLink system that the pill box has been opened.
All patients completed the 4-week field trial. Although there was widespread agreement on the concept of brain death, differences were detected in the clinical practices of determining brain death Wijdicks ; Hornby et al However, these programs require staff reassignment or resources that are not available.
Feedback interviews revealed that patients were generally neutral about the assessments. However, MedLink did have a Settings section where users could make minor adjustments to the app, such as font size.
Medicine with Me: Medlink Research Paper
Evidence review and recommendations for future research in mental health. A cohort study of adherence to antidepressants in primary care: We are currently beginning a week randomized controlled trial to evaluate whether MedLink improves medication adherence and depression relative to usual care, which will answer some of these questions.
Perhaps because of its wide-ranging application to almost all questions of human social cognition and behavior, theory of mind research has extended mrdlink beyond the domains of comparative and developmental psychology.
Lessons were viewed an average of General medicine physicians often do not manage medications according to treatment guidelines [ 8 ], and communication between patients and physicians is poor, aggravating the problem.
Am J Manag Care.
Discontinuation of use and switching of antidepressants: While the adherence rates far exceeded what would be expected in general clinical 2041, it is possible, and indeed likely, that the patient sample was not representative of the average clinic patients starting an antidepressant medication. Patient-facing tools aim to: Physicians were very clear in the focus groups that anything that increased workload or did not fit ressarch their usual workflow would likely not be accepted.
This presents both opportunities and challenges.
This article includes discussion of brain death, brainstem death, cerebral death, death by brain criteria, and death by neurologic criteria. While delays occurred to some extent for all patients, they were more pronounced for some patients, likely due to poor connectivity in their homes. Prospective studies of adverse events related to antidepressant discontinuation. The Macarthur initiative on depression and primary care at Darmouth and Duke: J Am Med Inform Assoc ; However, this asks users to make choices about interaction methods before they have experience with the app and thus may also result in suboptimal selections.
MedLink was designed to include a patient-facing mobile app, a cellularly enabled pill bottle to track medication adherence, and physician decision support.