Chai Peter R, Carreiro Stephanie, Innes Brendan J, Rosen Rochelle K, O'Cleirigh Conall, Mayer Kenneth H, Boyer Edward W
Division of Medical Toxicology, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States.
Division of Medical Toxicology, Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, United States.
J Med Internet Res. 2017 Jan 13;19(1):e19. doi: 10.2196/jmir.7050.
Nonadherence to prescribed regimens for opioid analgesic agents contributes to increasing opioid abuse and overdose death. Opioids are frequently prescribed on an as-needed basis, placing the responsibility to determine opioid dose and frequency with the patient. There is wide variability in physician prescribing patterns because of the lack of data describing how patients actually use as-needed opioid analgesics. Digital pill systems have a radiofrequency emitter that directly measures medication ingestion events, and they provide an opportunity to discover the dose, timing, and duration of opioid therapy.
The purpose of this study was to determine the feasibility of a novel digital pill system to measure as-needed opioid ingestion patterns in patients discharged from the emergency department (ED) after an acute bony fracture.
We used a digital pill with individuals who presented to a teaching hospital ED with an acute extremity fracture. The digital pill consisted of a digital radiofrequency emitter within a standard gelatin capsule that encapsulated an oxycodone tablet. When ingested, the gastric chloride ion gradient activated the digital pill, transmitting a radiofrequency signal that was received by a hip-worn receiver, which then transmitted the ingestion data to a cloud-based server. After a brief, hands-on training session in the ED, study participants were discharged home and used the digital pill system to ingest oxycodone prescribed as needed for pain for one week. We conducted pill counts to verify digital pill data and open-ended interviews with participants at their follow-up appointment with orthopedics or at one week after enrollment in the study to determine the knowledge, attitudes, beliefs, and practices regarding digital pills. We analyzed open-ended interviews using applied thematic analysis.
We recruited 10 study participants and recorded 96 ingestion events (87.3%, 96/110 accuracy). Study participants reported being able to operate all aspects of the digital pill system after their training. Two participants stopped using the digital pill, reporting they were in too much pain to focus on the novel technology. The digital pill system detected multiple simultaneous ingestion events by the digital pill system. Participants ingested a mean 8 (SD 5) digital pills during the study period and four participants continued on opioids at the end of the study period. After interacting with the digital pill system in the real world, participants found the system highly acceptable (80%, 8/10) and reported a willingness to continue to use a digital pill to improve medication adherence monitoring (90%, 9/10).
The digital pill is a feasible method to measure real-time opioid ingestion patterns in individuals with acute pain and to develop real-time interventions if opioid abuse is detected. Deploying digital pills is possible through the ED with a short instructional course. Patients who used the digital pill accepted the technology.
不遵守阿片类镇痛药的规定用药方案会导致阿片类药物滥用和过量死亡增加。阿片类药物通常是按需开具处方，患者需自行决定阿片类药物的剂量和服用频率。由于缺乏描述患者实际按需使用阿片类镇痛药情况的数据，医生的处方模式存在很大差异。数字药丸系统具有一个射频发射器，可直接测量药物摄入事件，为了解阿片类药物治疗的剂量、时间和持续时间提供了机会。
本研究旨在确定一种新型数字药丸系统用于测量急性骨折后从急诊科（ED）出院患者按需服用阿片类药物情况的可行性。
我们让因急性四肢骨折就诊于教学医院急诊科的患者使用数字药丸。数字药丸由一个标准明胶胶囊内的数字射频发射器组成，该胶囊包裹着一片羟考酮片。服用后，胃内氯离子梯度会激活数字药丸，发射一个射频信号，由佩戴在髋部的接收器接收，然后将摄入数据传输到基于云的服务器。在急诊科进行简短的实际操作培训后，研究参与者出院回家，使用数字药丸系统按需服用羟考酮以缓解疼痛，为期一周。我们进行药丸计数以验证数字药丸数据，并在参与者后续的骨科预约就诊时或研究入组一周后对其进行开放式访谈，以确定他们对数字药丸的知识、态度、信念和实践情况。我们使用应用主题分析法对开放式访谈进行分析。
我们招募了10名研究参与者，记录了96次摄入事件（准确率87.3%，96/110）。研究参与者报告称，经过培训后他们能够操作数字药丸系统的各个方面。两名参与者停止使用数字药丸，称他们疼痛过于剧烈，无法专注于这项新技术。数字药丸系统检测到数字药丸系统的多次同时摄入事件。在研究期间，参与者平均服用了8（标准差5）粒数字药丸，4名参与者在研究期结束时仍继续服用阿片类药物。在现实世界中与数字药丸系统互动后，参与者发现该系统非常可接受（80%，8/10），并表示愿意继续使用数字药丸来改善药物依从性监测（90%，9/10）。
数字药丸是一种可行的方法，可用于测量急性疼痛患者的实时阿片类药物摄入情况，并在检测到阿片类药物滥用时制定实时干预措施。通过在急诊科进行简短的教学课程即可部署数字药丸。使用数字药丸的患者接受了这项技术。
