SBIR-STTR Award

To help patients adhere to medication regimens, medical providers must have detailed information about their patients' adherence. This requires systemic and thorough question about patients' understanding of their medications, their medication adherence, and reasons for non-adherence, tasks that may require more time and attention than providers can offer. Computers are increasingly being used to augment patient history taking, reliving medical providers from time-consuming tasks, while providing them with valuable information about their patients. We propose to develop a computerized medication adherence assessment to gather information about patients' understanding of their medication regimen, adherence, and reasons for non-adherence. The assessment also will produce a report of patient adherence and reasons for non-adherence. In Phase I, we will develop a prototype focusing on HIV medications. Using a diverse sample of patients and providers, we will evaluate the feasibility and acceptability of the computerized assessment and compare the computerized assessment data with provider estimates of patient adherence. In Phase II, we will expand the database of medications and add an adherence enhancement component that will analyze patient non-adherence patterns and produce individualized provider and patient guidelines to help providers enhance patients adherence and to help patients enhance their own adherence. PROPOSED COMMERCIAL APPLICATION: The primary market for the proposed computerized medication adherence assessment will be medical providers who practice in outpatient primary care clinics. With the move towards managed care, primary care providers are being asked to perform more tasks in shorter amounts of time. A tool that would save them the time of conducting assessments while providing them with valuable information about their patients would have strong commercial potential.

Highly active antiretroviral therapy for HIV produces dramatic reductions in morbidity and mortality for many individuals who maintain a very high level of adherence to their medications. Between 20 and 33 percent of HIV-seropositive patients will miss at least one of their medication doses over a 1 to 3 day period. To improve patient adherence, we must accurately assess non-adherence and intervene to enhance adherence. Patient self-report is the most practical method for assessing adherence, but may produce unreliable and invalid results unless optimally performed. A computer-assisted, self-administered adherence program could improve HIV-seropositive patients' adherence behaviors by accurately and efficiently assessing their medication adherence, delivering an adherence intervention to patients, and producing adherence reports for providers. Patients could routinely complete the program with minimal use of valuable and costly medical staff time. By providing a neutral and seemingly private interview, computer programs may increase patient disclosure of non-adherence. In Phase I, we successfully developed a computerized HIV medication assessment that identified serious patient medication errors and non-adherence. Phase II efforts will be directed toward simplifying the adherence assessment, developing the intervention component of the adherence program, and testing the complete program's efficacy in reducing regimen misunderstandings and enhancing patient adherence. PROPOSED COMMERCIAL APPLICATIONS: Because of their heavy financial investment in improving patient adherence, a strategic alliance with a pharmaceutical company will be our primary marketing strategy. Because nonadherence increases patient morbidity and health care costs, health maintenance organizations would be a second potential market. Individual health care providers may be a third market.

Thesaurus Terms:
AIDS therapy, combination chemotherapy, computer assisted patient care, computer data analysis, computer system design /evaluation, self care, therapy compliance antiAIDS agent, chemical information system, computer assisted instruction questionnaire