SBIR-STTR Award

Individuals suffering from Serious and Persistent Mental Illnesses (SPMI) are at risk for adverse psychiatric, somatic health, and social outcomes with higher rates of heart disease, high blood pressure, obesity, and diabetes. Essential to controlling chronic psychiatric and health disorders is improved care coordination and adherence to prescriptions that address the symptoms and causes of these health conditions. Unfortunately, adherence rates for individuals diagnosed with SPMI is 50- 70% of prescribed somatic and psychiatric medications, well under the 80% considered adherent. Improving adherence is challenging for community mental health providers due to difficulty identifying non-adherent patients and devising personalized interventions. The lack of real-time information on patient adherence leads to medication and dosing changes which complicate patient adherence, further interfering with the provider?patient relationship and making care coordination more difficult. To address these issues Terrapin Pharmacy and Medherent? developed an integrated medication dispensing device and adherence support platform. Medherent? is a ?smart? vending machine that incorporates a networked Android tablet and is loaded with a 30 days? supply of the consumer?s medications prepared in multi-dose packets by the pharmacy?s robotic technology. Using the cellular Android tablet, the device?s activation by the consumers causes an electronic medication record to be populated showing that medication to be taken and the time of dispensing. Terrapin Pharmacy and the University of Maryland have been pilot testing the Medherent device and system in the homes of 46 community mental health clients. During this pilot, consumers have independently dispensed their medication at a rate exceeding 93 percent of their prescribed daily dosing schedules, and both consumers and providers report high levels of satisfaction with the device. This FastTrack Phase I and Phase II project builds on the pilot testing of the Medherent? device. Phase I will test the usability of the device, develop manuals and interventions built on the device and enhance the interface and connectivity of the platform. Phase II proposes a randomized stepped wedge design study with 150 clients to assess the correspondence between Medherent activation and medication adherence and the clinical effects of the Medherent device and to further refine the device and platform?s interface. The Phase II study will yield a fully functional, market-ready adherence platform and pharmacy service with data to quantify the effect on client adherence and manualized interventions for deployment by community mental health agencies. The primary target market for the platform is community mental health agencies serving individuals with SPMI or other health care entities that serve chronically ill individuals requiring adherence support. Throughout the study period, existing relationships with the community health agencies and providers will be further developed to ensure that the platform meets customer needs.

Project Terms:
Acute; Address; Adherence; Administrator; Adoption; Android; Attitude; Behavior; Biological; Bipolar Disorder; Cardiovascular Diseases; care coordination; care systems; Caring; Case Manager; Chronic; Chronically Ill; Client; Clinical; Clinical Data; clinical effect; Communities; Community Health; community setting; Comorbidity; comparison group; Compliance behavior; Computer software; cost; Data; Data Reporting; Databases; Depressive disorder; design; Devices; Diabetes Mellitus; Diagnosis; Disease; Distress; Dose; Education; Effectiveness; Electronic Health Record; Emergency department visit; Enrollment; Ensure; evidence base; Expenditure; experience; Exposure to; Feedback; Frequencies; Funding; Future; Health; Health Personnel; health service use; Health Services; Healthcare; Heart Diseases; Heart Rate; High Prevalence; Home environment; Hospitalization; Hypertension; improved; Individual; Intervention; Interview; Knowledge; Legal patent; Life; Manuals; Maryland; Measures; Medicaid; medication compliance; Medication Management; Mental Health; Methods; mobile application; Modeling; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Operating System; Outcome; Participant; Patient Self-Report; Patients; Perception; personalized care; personalized intervention; Pharmaceutical Preparations; Pharmaceutical Services; Pharmacological Treatment; Pharmacy facility; Phase; phase 2 study; physical conditioning; Population; preference; product development; Protocols documentation; Provider; Psyche structure; Randomized; recruit; Reporting; Research Design; Risk; Robotics; satisfaction; Schedule; Schizophrenia; Schools; Services; severe mental illness; Small Business Innovation Research Grant; social; Social Work; Structure; Substance abuse problem; Suicide; Symptoms; System; Tablet Computer; Tablets; Technology; terrapin; Testing; Time; Training; treatment arm; Universities; usability; web app;

Individuals suffering from Serious and Persistent Mental Illnesses (SPMI) are at risk for adverse psychiatric, somatic health, and social outcomes with higher rates of heart disease, high blood pressure, obesity, and diabetes. Essential to controlling chronic psychiatric and health disorders is improved care coordination and adherence to prescriptions that address the symptoms and causes of these health conditions. Unfortunately, adherence rates for individuals diagnosed with SPMI is 50- 70% of prescribed somatic and psychiatric medications, well under the 80% considered adherent. Improving adherence is challenging for community mental health providers due to difficulty identifying non-adherent patients and devising personalized interventions. The lack of real-time information on patient adherence leads to medication and dosing changes which complicate patient adherence, further interfering with the provider–patient relationship and making care coordination more difficult. To address these issues Terrapin Pharmacy and Medherent™ developed an integrated medication dispensing device and adherence support platform. Medherent™ is a “smart” vending machine that incorporates a networked Android tablet and is loaded with a 30 days’ supply of the consumer’s medications prepared in multi-dose packets by the pharmacy’s robotic technology. Using the cellular Android tablet, the device’s activation by the consumers causes an electronic medication record to be populated showing that medication to be taken and the time of dispensing. Terrapin Pharmacy and the University of Maryland have been pilot testing the Medherent device and system in the homes of 46 community mental health clients. During this pilot, consumers have independently dispensed their medication at a rate exceeding 93 percent of their prescribed daily dosing schedules, and both consumers and providers report high levels of satisfaction with the device. This FastTrack Phase I and Phase II project builds on the pilot testing of the Medherent™ device. Phase I will test the usability of the device, develop manuals and interventions built on the device and enhance the interface and connectivity of the platform. Phase II proposes a randomized stepped wedge design study with 150 clients to assess the correspondence between Medherent activation and medication adherence and the clinical effects of the Medherent device and to further refine the device and platform’s interface. The Phase II study will yield a fully functional, market-ready adherence platform and pharmacy service with data to quantify the effect on client adherence and manualized interventions for deployment by community mental health agencies. The primary target market for the platform is community mental health agencies serving individuals with SPMI or other health care entities that serve chronically ill individuals requiring adherence support. Throughout the study period, existing relationships with the community health agencies and providers will be further developed to ensure that the platform meets customer needs.

Public Health Relevance Statement:
Project Narrative Maintaining high levels of adherence to psychiatric and somatic medication and improving coordination of care is necessary to improve the health of individuals living with severe mental illness. Current methods for identifying non-adherent individuals and personalizing care is limited This Fast-Track Phase I - Phase II SBIR project will rigorously evaluate the Medherent™ medication management device; the proposed project will yield a market-ready, scalable, platform for improving consumer adherence, providing real-time feedback to providers about client adherence and provide a platform for future integration of other real time health information to improve coordination of care and responsiveness.

NIH Spending Category:
Behavioral and Social Science; Brain Disorders; Cardiovascular; Clinical Research; Clinical Trials and Supportive Activities; Health Services; Mental Health; Mental Illness; Networking and Information Technology R&D (NITRD); Patient Safety; Schizophrenia; Serious Mental Illness

Project Terms:
Acute; acute stress; Address; Adherence; adherence rate; Administrator; Adoption; Android; Attitude; behavioral adherence; Biological; Bipolar Disorder; Cardiovascular Diseases; care coordination; care systems; Case Manager; Chronic; Chronically Ill; Client; Clinical; Clinical Data; clinical effect; Communities; Community Health; community setting; comorbidity; comparison group; compliance behavior; Computer software; cost; Data; Data Reporting; Databases; Depressive disorder; design; Devices; Diabetes Mellitus; Diagnosis; Disease; Distress; Dose; Education; Effectiveness; Electronic Health Record; Emergency department visit; Enrollment; Ensure; evidence base; Expenditure; experience; Exposure to; Feedback; Frequencies; Funding; Future; General Population; Health; Health Personnel; health service use; Health Services; Healthcare; Heart Diseases; Heart Rate; High Prevalence; Home environment; Hospitalization; Hypertension; improved; Individual; Intervention; Interview; Knowledge; Legal patent; Life; Manuals; Maryland; Measures; Medicaid; medication compliance; Medication Management; Mental Health; Methods; mobile application; Modeling; Non-Insulin-Dependent Diabetes Mellitus; Obesity; off-patent; Operating System; Outcome; Participant; Patient Noncompliance; Patient Self-Report; Patients; Perception; personalized care; personalized intervention; Pharmaceutical Preparations; Pharmaceutical Services; Pharmacological Treatment; Pharmacy facility; Phase; phase 2 study; physical conditioning; Population; preference; product development; Protocols documentation; Provider; Psyche structure; Randomized; recruit; Reporting; Research Design; Risk; Robotics; satisfaction; Schedule; Schizophrenia; Schools; Services; severe mental illness; Small Business Innovation Research Grant; smart home; social; Social Work; Structure; Substance abuse problem; Suicide; Symptoms; System; Tablet Computer; Tablets; Technology; terrapin; Testing; Time; Training; treatment arm; Universities; usability; web app