Lee Jeannie K, Nicholas J Skye, Albadawi Amani, Insel Kathleen C
Department of Pharmacy Practice & Science, The University of Arizona R. Ken Coit College of Pharmacy, Tucson, AZ, United States.
The University of Arizona College of Nursing, Tucson, AZ, United States.
Front Drug Saf Regul. 2025 Mar 13;5:1476998. doi: 10.3389/fdsfr.2025.1476998. eCollection 2025.
Adherence to hypertension medications is low among older people, and there is limited guidance on the safety of taking a missed medication. Knowing the window of time when an older individual can safely take a missed medication could improve adherence and reduce the fear of overdosing. We developed and implemented a decision support algorithm for missed hypertension medications in a digital therapeutic system designed to facilitate self-management of hypertension medications and blood pressure among older adults.
The medication formulary included hypertension medications and doses available in the United States that are safe for use by older people. The decision support algorithm was developed through a literature review of clinical and pharmacokinetic studies and knowledge of the pharmacology of aging (pharmacokinetics and pharmacodynamics). The algorithm was peer-reviewed and checked against available provider and patient instructions about missed hypertension medications. Case scenarios were used to code the algorithm into the app.
A total of 117 hypertension medications and combination products were included in the formulary of the (MEDSReM) system, a mobile digital therapeutic. The formulary contains medication names and dose options available for selection at onboarding or when medication changes occur. The safe window for taking missed/overdue medication was programmed into the MEDSReM app for each medication and dosing frequency. The users are presented with "take, snooze, and skip" options when they receive a reminder and open the app to take the medication. If they open the app past the safe window hours, a recommendation to skip that dose and take the next dose at the regular time is presented. If the user decides to take the missed dose, a decision to take or skip the next dose is shown.
The MEDSReM decision support algorithm provides a safe window of time for each hypertension medication for older adults when they need to take their medication after the intended target time has passed. The interdisciplinary collaboration of clinical, technology, and research teams resulted in a novel, older adult-centered, time-specific digital therapeutic intervention to support decision-making about taking missed hypertension medications.
老年人对高血压药物的依从性较低，而且关于漏服药物安全性的指导有限。了解老年人能够安全补服漏服药物的时间窗，有助于提高依从性并减少过量服药的担忧。我们在一个旨在促进老年人高血压药物自我管理和血压管理的数字治疗系统中，开发并实施了一种针对漏服高血压药物的决策支持算法。
药物处方集包含美国可供老年人安全使用的高血压药物及其剂量。决策支持算法是通过对临床和药代动力学研究的文献综述以及对衰老药理学（药代动力学和药效学）的了解而开发的。该算法经过同行评审，并与现有的医生和患者关于漏服高血压药物的说明进行核对。使用案例场景将算法编码到应用程序中。
移动数字治疗系统（MEDSReM）的处方集中总共包含117种高血压药物及复方制剂。该处方集包含在注册时或发生药物变更时可供选择的药物名称和剂量选项。每种药物和给药频率的补服/逾期服药安全时间窗都已编入MEDSReM应用程序。当用户收到提醒并打开应用程序服药时，会看到“服用、推迟、跳过”选项。如果他们在安全时间窗过后打开应用程序，会给出跳过该剂量并在常规时间服用下一剂的建议。如果用户决定服用漏服的剂量，则会显示关于是否服用下一剂的决策。
MEDSReM决策支持算法为老年人提供了每种高血压药物在预期服药时间过后需要服药时的安全时间窗。临床、技术和研究团队的跨学科合作产生了一种新颖的、以老年人为中心的、特定时间的数字治疗干预措施，以支持关于补服高血压药物的决策。
