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CONSIGNELA: Real-time Electronic Medication Prescription Comprehension Tool

The CONSIGNELA Project aims to improve medication prescription comprehension in older adults and patients with Parkinson's Disease. This research tool provides real-time analysis and study of electronic medication instructions.

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CONSIGNELA: Real-time Electronic Medication Prescription Comprehension Tool

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  1. CONSIGNELA-Appli-R-1.0: A research tool for studying in real time electronic medication prescription comprehension in older adults and patients with Parkinson’s disease Vandenbergh*, Élodie ; Wanderley**, Gregory Moro Puppi ; Abel**, Marie-Hélène ; Barthès**, Jean-Paul ; Hainselin*, Mathieu ; Moulin**, Claude ; Mouras*, Harold & Heurley*, Laurent CRP-CPO EA 7273 - Université de Picardie Jules Verne, Amiens, France ** HEUDIASYC UMR CNRS 7253 - Sorbonne Universités, Université de Technologie de Compiègne, Compiègne, France elodie.vandenbergh@gmail.com / laurent.heurley@u-picardie.fr

  2. The CONSIGNELA Project • Context: the presentstudyis part of the CONSIGNELA Project CONSIGNELA = CONSIGNes Électroniques Adaptées (Adaptedelectronic instructions) • Goal: to improve drug prescription comprehension and execution in elderly and parkinsonian patients • Funding: • Partners:

  3. Medication non-adherence • Medication non-adherence (non-compliance) • Non-adherence = deviationsfromprescription • Veryfrequent:  50% non-adherent patients • Consequences: reducedquality of life, rehospitalisations,… death. • Multifactorial and complexphenomenon (Baudrant-Boga, Lehmann, &Allenet, 2012) • Older patients: Three important factors(Morrow et al., 2004) • Regimencomplexity • Age-related and chronicdiseases-realteddecrease • Inadequate patient-provider communication

  4. Regimen complexity • Multiple chronic disease & polypharmacy: • Multiple chronic illnesses (Bainbridge & Ruskin, 2009) • “many drugs” or “too many drugs” • Self-medication(Bainbridge & Ruskin, 2009) • Complex and changing administration schedules (e.g. Parkinson’s disease): • Multiple doses at different moments of the day (Bainbridge & Ruskin, 2009) • Multiple changes in the patient’s therapy (Malek& Grosset, 2015)

  5. Cognitive capacities of elderly and parkinsonian patients (Altgassen, Phillips, Kopp, & Kliegel, 2007; Collette & Salmon, 2014; Guillaume, Guillery-Girard, Eustache, & Desgranges, 2009; Insel, Einstein, Morrow, & Hepworth, 2013; Lauverjeat, Pennequin, & Fontaine, 2005; Pigott et al., 2015)

  6. Inadequate patient-provider communication • Different sources and standard (inadequate) documents: • Oral instructions: • Doctor’s instructions • Pharmacist’s instructions • Other sources (e.g., internet, etc.) • Visual instructions: • Doctor’s prescription • Medicationleaflet and package • Annotations written by the pharmacist • Other sources (e.g., internet, etc.) • (McCarthy et al., 2012; Serper et al., 2013; Tarn et al., 2008; Wolf et al., 2007, 2009)

  7. Inadequate patient-provider communication • Written or printed « ordonnance » • « prescription » • Patient information leaflet • Package insert • Package information • Annotations written by the • pharmacist Source: http://www.popcenter.org/problems/prescription_fraud/print/ Source: https://www.shop-pharmacie.fr/p/ibufetum-ibuprofene-gel-5-60-g-10002093.html • Too many sources

  8. Inadequate patient-provider communication • « Ordonnance » • « Prescription » Source : http://medicalschoolhq.net/prescription-writing-101/ • Inadequate presentation Source : www.droitpharma.fr/8/ordo_reg.htm

  9. How to improve patient-provider communication? • How to make prescriptions more understandable? … by adopting a multidisciplinary patient-centered approach: • Medical • Cognitive • Technological (Morrow et al., 2004; Morrow, 2015)

  10. Medical patient-centered approach • Simplifications and visualaids: • Lexical simplification • Visual aids: tables, illustrations (pictograms or photographs), medicationschedules (Chuang, Lin, Wang, & Cham, 2010) (Morrow, Leirer, Andrassy, Hier, & Menard, 1998)

  11. Medical patient-centered approach • Table format is often used as an aid to communicate « prescriptions » (Cordasco et al., 2009) (Hawkins & Firek, 2014)

  12. Medical patient-centered approach • Table format: MedtableTM (Morrow et al., 2008)

  13. Medical patient-centered approach • Table format advantages: • Integrated presentation of information • Spatialisation of information • More concretethan verbal instructions  bettercomprehension • Isomorph to pillboxfillingtask • Adapted to patients withlowhealthliteracy / lowlevel of education

  14. Cognitive patient-centered approach • Cognitive psychology and cognitive neuropsychology: • Concepts:procedural documents, mental model (situationalmodels) • Models:procedural document processing • Methods:experimentalparadigms

  15. Cognitive patient-centered approach / concepts • Procedural documents • Proceduraldocuments = documents designed to communicateprocedures • Procedures= actions to execute to reach a goal • One must distinguish: PRESCRIPTION and «Prescription»: • PRESCRIPTION = procedurethat patients shouldexecute « prescriptions » & « ordonnances » « table medicationschedules » = proceduraldocuments Visual aids • A « prescription » is a specificreification of a PRESCRIPTION

  16. Cognitive patient-centered approach / concepts • PRESCRIBER • PROCEDURAL DOCUMENT(S) • PATIENT • PRESCRIPTION (procedure): • How to take drugs • Instructions given in a particular format • Actions • What is the most adequate presentation format and why?

  17. Cognitive patient-centered approach / concepts • To execute instructions from a procedural document: A complextask • Multiple cognitive processes involved : • Understanding= mental model (Ganier, 2004) / situation model (Morrow, 2015) “For medication instructions, the situation model represents how to take the medication, including how much to take, when to take it, and what warnings to keep in mind” (Morrow et al., 1998) • Remembering (episodic and semantic memory) • Planning(prospective memory) • Deciding and monitoring • Acting (procedural memory; motor planning, control and execution)

  18. Cognitive patient-centered approach / models • Presentation format  mental model construction • Illustrations: + • Animations: + - • Table format: + ? A model of procedural document processing Source : Ganier (2004)

  19. Technological patient-centered approach Healthcare technologicaltools • Goal : to help patients and to improveadherencewithergonomicaltools • Someexamples: • Tablets to conveymedical information • Smartphones  to help patients rememberingdrugtaking • ElectronicalMedicationSchedules  patient-prescriber collaboration

  20. Technological patient-centered approach • Touchscreens and tablets: (Piper & Hollan, 2013)

  21. Technological patient-centered approach (Slagle et al., 2010) (Walker et al., 2014)

  22. Technological patient-centered approach • Electronic collaborative tools: Electronic Medical Record (EMR) – integrated tool and Medtable™ (Morrow, 2015; Morrow et al., 2012)

  23. Technological patient-centered approach Research tools • Goal: to study cognitive processes involved in prescription comprehension • Procedure: to collect behavioral (actions) and chronometric (time) data

  24. Technological patient-centered approach Eye-movementrecording technique SMI Glasses Eraslan, S., Yesilada, Y., and Harper, S. (2016). Remote SMI device

  25. Technological patient-centered approach Moving-window Moving-window technique (Heurley, 1994)

  26. Technological patient-centered approach Blurred text • TIP–EXE software (Ganier & Querrec, 2012) • Text & picture presentation • Moving-window technique • Information recorded: • Reading ExposureTime • Reading path • Execution time • Execution errors

  27. CONSIGNELA-Appli-R v1.0 • Objective: • This tool is designed for recording in real time behavioral and temporal indicators while patients will consult and executeprescriptions displayed on tablets • Main features • Research tool for tablets • Moving-window technique • Prescription can be displayed into three formats: verbal, tabular, circular • Pillbox filling task simulation: tabular & circular pillbox • Behavioral and temporal indicators

  28. Participants • Objectives of the pilot study: • Impact of prescription format • Impact of pillbox format Prescription format Pillbox type • Tabular • Circular • Verbal Tabular 6 groups • Tabular • Circular • Verbal Circular

  29. Material / Prescription format • Prescription: 4 medications / 6 days • 3 formats: tabular vs. verbal vs circular Circular Verbal Tabular

  30. Material / Regimen complexity • Medication type: • 2 regular intake medications • 2 irregular intake medications Irregular intake Regular intake

  31. Material / Moving windows • Moving-window technique: Step 1 : Click on the medication picture Step 2 : Consult the medication prescription

  32. Material / Pillbox • Pillbox type: Tabular pillbox Circular pillbox

  33. Material / Tabular pillbox filling Step 1: Open a compartment of the pillbox X 2

  34. Material / Tabular pillbox filling Step 2: Fill the pillbox with medication

  35. Material / Circular pillbox filling X 1

  36. Material / Pillbox filling - 1 1 2 + 1 4 3

  37. Procedure Prescription studying Pillbox filling Automatic recording of action and chronometric data in a data file

  38. Data output • Actions • Start consultation • DOLIPIT consultation • ANVIRAX consultation • Start pillboxfilling • Open MondayMorningCompartment • ANVIRAX selection • …

  39. Recorded data • Time • Studying Time (ST) • Execution Time (ET) • (pillbox) • Actions • Number of returns to the prescription • Number of corrections

  40. Recorded data • Prescription = 4 medications • Studying time / prescription • Execution time / pillbox • Studying time / medication • Execution time / medication - Studying time / regular medication - Execution time / regular medication …

  41. Recorded data Pillbox filling 1 Prescription studying 2 Pillbox filling 2 Prescription studying 1 • Prescription studying time • Pillboxexecution time • Prescription studying #1 • Pillboxfilling time #1

  42. Recorded data / Prescription studying activity • Studying time • Total studying time • Studying time / medication • Studying time / prescription studying • Actions • Number of returns to the prescription

  43. Recorded data / Pillbox filling activity Execution time Actions Number of actions Number of medication used Number of medication corrections Executionaccuracy • Total execution time • Execution time / medication • Execution time / Pillox Filling • Pillboxfilling score

  44. Pillbox filling score (%) (Vandenbergh, 2015) Dose filling score (%) Moment filling score (%) Global filling score (%) Recorded data / Pillbox filling • Empty pillbox or • 0% correct • 100% correct • SCORE • 0 % 100 %

  45. Results • Time (s)

  46. Results • Time (s)

  47. Results ** NS ** • Studying time (s) • Verbal • Circular • Tabular • Presentation format ** p < 0.01 (NS) Non significant

  48. Results NS • Studying time (s) • Circular • Tabular • Pillbox type ** p < 0.01 (NS) Non significant

  49. Results NS NS ** • Studying time (s) • Tabular pillbox • Tabular pillbox • Tabular pillbox • Circular pillbox • Circular pillbox • Circular pillbox • Tabular • Verbal • Circular • Prescription format

  50. Conclusion • CONSIGNELA-Appli-R-1.0 • Good effectiveness and fiability • Manyindicatorsavailable • Researchtool Non ecological Biasescontroled • 2nde phase: elderly people and parkinsonian patients

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