Home » Exploring the Intersection of Healthcare and Technology: Journey into Medication Adherence Research

Exploring the Intersection of Healthcare and Technology: Journey into Medication Adherence Research

A Short-Term Scientific Mission experience Switzerland - Spain

Janette Ribaut, Postdoctoral Researcher Institute for Nursing Science (INS; Institut für Pflegewissenschaft), University of Basel, Switzerland

With my background in nursing, I have always been passionate about understanding and supporting medication adherence behaviors. However, it was only during my PhD that I truly delved deeper into the technologies related to this crucial aspect of healthcare. This journey led me to participate in a project aimed at developing/adapting, implementing, and evaluating an integrated care model (ICM) facilitated by eHealth to support self-management, including medication adherence, in patients undergoing allogeneic stem cell transplantation: the SMILE project.

Bridging the Gap with the SMILe-ICM

Designing and implementing complex interventions into clinical practice is often challenging due to several factors:

  • Lack of adaptation to context-specific conditions
  • Absence of theoretical frameworks to guide eHealth integration
  • Failure to embrace a user-centered design approach

To overcome these challenges, we combined methods from implementation science, behavioral science, and computer science in developing, implementing, and testing the SMILe-ICM [1]. An important first step was conducting a contextual analysis at each participating center [2-3]. We learned that both patients and clinicians were open to using technology but emphasized that it should not replace human contact.

Components of the SMILe-ICM

The fully developed SMILe-ICM consists of two main components:

  1. Advanced Practice Nurse (APN) Team: The APNs provide 12 face-to-face visits in the first year post-alloSCT to foster patients’ self-management and health behavior concerning symptom evaluation, medication adherence, physical activity, and infection prevention.
  2. SMILe Technology: This includes the SMILeApp and SMILeCare. Patients use the SMILeApp to reinforce self-management information and submit key medical, symptom, and behavioral parameters (i.e., medication adherence) daily. The APN can view this data via SMILeCare, respond to changes, and adjust intervention visits accordingly.
Implementing and Testing the SMILe-ICM

The SMILe-ICM and its contextually adapted version were implemented and tested at the University Hospitals in Freiburg, Germany, and Basel, Switzerland [4]. We are currently conducting another contextual analysis for future adaptation and implementation at UZ Leuven in Belgium. In the initial centers, patients appreciated the SMILe-ICM, particularly the blend of human and technological components. The holistic approach of embedding important health topics like medication adherence and symptom monitoring into an integrated care model proved beneficial for both patients and their families. However, we faced some barriers, particularly concerning the long-term financing of the ICM.

Expanding Horizons with ENABLE
The process of developing and evaluating technology captured my interest, which I further explored thanks to Working Group (WG) 2 of the ENABLE cost action and my Short-Term Scientific Mission (STSM) with Alexandra Dima and the PRISMA research group at Parc Sanitari Sant Joan de Déu (PSSJD) in Barcelona, Spain. WG 2 aims to develop the ENABLE online repository to improve access to best-practice medication adherence technologies (MATech) across Europe. An initial version of the repository structure was iteratively developed by the WG2 steering committee based on literature reviews and discussions. I led the development of descriptors for MATech’s “development and evaluation”. During my STSM, Alex and I worked closely to refine these descriptors based on Delphi survey results [5] and scientific literature. We also developed questions for a form to collect the needed information for the repository and a user guide to assist those filling out the form.
Sharing Our Work

Finally, our work and results were presented at the ESPACOMP conference 2022 in Berlin. This experience not only deepened my understanding of medication adherence technologies but also highlighted the importance of collaboration and knowledge sharing in advancing healthcare practices.

I invite you to follow our journey on the ENABLE blog, where we showcase user experiences and expert reviews of adherence technologies, aiming to raise awareness and foster better health outcomes.

References:

    1. Leppla, L., Schmid, A., Valenta, S., Mielke, J., Beckmann, S., Ribaut, J., … & De Geest, S. (2021). Development of an integrated model of care for allogeneic stem cell transplantation facilitated by eHealth—the SMILe study. Supportive Care in Cancer, 29, 8045-8057.

    2. Leppla, L., Mielke, J., Kunze, M., Mauthner, O., Teynor, A., Valenta, S., Vanhoof, J., Dobbels, F., Berben, L., Zeiser, R., Engelhardt, M., & De Geest, S. (2020). Clinicians and patients perspectives on follow-up care and eHealth support after allogeneic hematopoietic stem cell transplantation: A mixed-methods contextual analysis as part of the SMILe study. European Journal of Oncology Nursing, 45, 101723. https://doi.org/https://doi.org/10.1016/j.ejon.2020.101723

    3. Valenta, S., Ribaut, J., Leppla, L., Mielke, J., Teynor, A., Koehly, K., Grossmann, F., Gerull, S., Witzig-Brändli, V. & De Geest, S. (2023). Context-specific adaptation of an eHealth-facilitated, integrated care model and tailoring its implementation strategies – a mixed-methods study as a part of the SMILe implementation science project. Frontiers in Health Services, section Implementation Science, 2:977564. doi: 10.3389/frhs.2022.977564

    4. De Geest, S.*, Valenta, S.* (*joint first authors), Ribaut, J., Gerull, S., Mielke, J., Simon, M., Bartakova, J., Kaier, K., Eckstein, J., Leppla, L.*, & Teynor, A.* (*joint last authors) (2022). The SMILe integrated care model in allogeneic SteM cell TransplantatIon faciLitated by eHealth: a protocol for a hybrid effectiveness-implementation randomised controlled trial. BMC Health Services Research, 22(1), 1067. https://doi.org/10.1186/s12913-022-08293-8

    5. Dima AL, Nabergoj Makovec U, Ribaut J, Haupenthal F, Barnestein-Fonseca P, Goetzinger C, Grant SP, Jácome C, Smits D, Tadic I, van Boven J, Tsiligianni I, Herdeiro MT, Roque F, European Network to Advance Best Practices and Technology on Medication AdherencE (ENABLE) Stakeholder consensus on an interdisciplinary terminology to enable development and uptake of medication adherence technologies across health systems: an online real-time Delphi study. JMIR Preprints. 28/04/2024:59738. DOI: 2196/preprints.59738