Rebecca Bartlett Ellis

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https://hdl.handle.net/1805/17675

Management of Medications and Adherence in People with Multiple Chronic Conditions

Taking medications as prescribed is challenging and remains a considerable barrier to people with chronic conditions realizing the full health benefits of prescribed treatments. Not adhering to a prescribed medication regimen involves missing doses, taking medications too early or late, or missing several days' doses. Many reasons can explain this nonadherence, but not developing reliable routine habits that ensure medications are taken and at the right time(taking and timing adherence) remains a significant barrier. Even minor deviations in dosing adherence can affect patient outcomes and may lead to erroneous conclusions about treatment efficacy, thus precipitating potentially unnecessary prescription changes (e.g. dose escalation, addition of medications, switching medications).

Dr. Rebecca Bartlett Ellis and her transdisciplinary team have developed a smart pillbox, known as InterACT Pillbox (patent pending), with embedded sensors that track medication-taking behaviors and provide feedback directly to users via their smart phone. The novelty of InterACT Pillbox lies in the integration of technology with widely used traditional pillboxes to provide continuous feedback to patients on how well they are taking medications as prescribed. InterACT Pillbox was co-designed with input from patients and is being used in intervention work to improve medication taking.

Dr. Ellis's work to improve patient medication taking is another example of how IUPUI faculty are TRANSLATING RESEARCH INTO PRACTICE.

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Now showing 1 - 10 of 23

The Medication Adherence Context and Outcomes Framework Image
(2018-10-04) Bartlett Ellis, Rebecca J.; Ruppar, Todd M.
Background: Adherence interventions have been largely ineffective, with most taking a "one-size-fits-all” approach without consideration of reasons for nonadherence. While the ABC Taxonomy clarified terminology and identified various outcomes measured along the process continuum, intervention design requires understanding the environments and contexts that contribute to nonadherence. A framework that combines the understanding of environment contextual influences, processes, and outcomes is needed to move forward with approaches to intervention design. Methods: Developed based on theory, practice, and research, the Medication-management and Adherence Contexts and Outcomes (MACO) framework describes the environmental contexts, the processes that occur within the contexts, and how these processes contribute to adherence outcomes. The MACO framework differentiates the processes, defined as medication management, within and across contexts that affect adherence outcomes. Results: Three distinct yet interrelated contexts identified in the MACO framework include 1.) clinic, 2.) pharmacy, and 3.) home. Conclusions: The MACO framework is a useful heuristic to understand at which point people experience problems with managing medications in the medication management continuum. This information can then be used for designing and delivering context-specific interventions and selecting appropriate outcome measures of adherence based on the contexts.
A study of Indiana University Health's spirit of inquiry and innovation during COVID
(Elsevier, 2021-07) Carpenter, Janet S.; Draucker, Claire B.; Bartlett Ellis, Rebecca J.; Ferren, Melora D.; Gilbert, Jason H.; Newhouse, Robin P.; Von Ah, Diane; School of Nursing
Background COVID-19 has required nursing innovations to meet patient care needs not previously encountered. Purpose The purpose of this study was to describe nursing innovations conceived, implemented, and desired during the first COVID-19 surge. Methods The investigators invited registered nurses employed across 16 Midwest hospitals (6,207) to complete the survey. Respondents provided demographics and written descriptions of innovations they conceived, witnessed, and desired. Investigators analyzed text responses using standard content analytic procedures and summarized quantitative demographics using percentages. Findings Nurses reported seven types of innovations that would (a) improve personal protective equipment (PPE), (b) limit the need to repeatedly don and doff PPE, (c) ensure safer practice, (d) conserve and access supplies, (e) provide patient and family education and support, (f) make team member communication more efficient, and (g) improve peer support. Discussion Nurses are in a unique position to generate innovative solutions to meet patient care needs under adverse and rapidly changing situations.
The Feasibility of a Using a Smart Button Mobile Health System to Self-Track Medication Adherence and Deliver Tailored Short Message Service Text Message Feedback
(JMIR, 2019-06-25) Bartlett Ellis, Rebecca J.; Hill, James H.; Kerley, K. Denise; Sinha, Arjun; Ganci, Aaron; Russell, Cynthia L.; School of Nursing
BACKGROUND: As many as 50% of people experience medication nonadherence, yet studies for detecting nonadherence and delivering real-time interventions to improve adherence are lacking. Mobile health (mHealth) technologies show promise to track and support medication adherence. OBJECTIVE: The study aimed to evaluate the feasibility and acceptability of using an mHealth system for medication adherence tracking and intervention delivery. The mHealth system comprises a smart button device to self-track medication taking, a companion smartphone app, a computer algorithm used to determine adherence and then deliver a standard or tailored SMS (short message service) text message on the basis of timing of medication taking. Standard SMS text messages indicated that the smartphone app registered the button press, whereas tailored SMS text messages encouraged habit formation and systems thinking on the basis of the timing the medications were taken. METHODS: A convenience sample of 5 adults with chronic kidney disease (CKD), who were prescribed antihypertensive medication, participated in a 52-day longitudinal study. The study was conducted in 3 phases, with a standard SMS text message sent in phases 1 (study days 1-14) and 3 (study days 46-52) and tailored SMS text messages sent during phase 2 (study days 15-45) in response to participant medication self-tracking. Medication adherence was measured using: (1) the smart button and (2) electronic medication monitoring caps. Concordance between these 2 methods was evaluated using percentage of measurements made on the same day and occurring within ±5 min of one another. Acceptability was evaluated using qualitative feedback from participants. RESULTS: A total of 5 patients with CKD, stages 1-4, were enrolled in the study, with the majority being men (60%), white (80%), and Hispanic/Latino (40%) of middle age (52.6 years, SD 22.49; range 20-70). The mHealth system was successfully initiated in the clinic setting for all enrolled participants. Of the expected 260 data points, 36.5% (n=95) were recorded with the smart button and 76.2% (n=198) with electronic monitoring. Concordant events (n=94), in which events were recorded with both the smart button and electronic monitoring, occurred 47% of the time and 58% of these events occurred within ±5 min of one another. Participant comments suggested SMS text messages were encouraging. CONCLUSIONS: It was feasible to recruit participants in the clinic setting for an mHealth study, and our system was successfully initiated for all enrolled participants. The smart button is an innovative way to self-report adherence data, including date and timing of medication taking, which were not previously available from measures that rely on recall of adherence. Although the selected smart button had poor concordance with electronic monitoring caps, participants were willing to use it to self-track medication adherence, and they found the mHealth system acceptable to use in most cases.
Creating a Professional Development Plan for a Simulation Consortium
(Elsevier, 2013-06) Jeffries, Pamela R.; Battin, Jim; Franklin, Michelle; Savage, Rhonda; Yowler, Hollace; Sims, Caroline; Hall, Tamara; Eisert, Shelly; Lauber, Cynthia; Brown, Stephanie; Werskey, Karen; Bartlett Ellis, Rebecca J.; Everage, Terri; Dorsey, Laurie; School of Nursing
As the United States struggles with health care reform and a nursing education system that inadequately prepares students for practice, dramatic advances in educational technology signal opportunities for both academic and practicing nurses to affect our profession as never before. Simulation technologies provide large and small institutions with the means to educate health care students and novice professionals effectively and efficiently through hands-on experience, but the costs of such a venture can be prohibitive. A simulation consortium offers a venue for different health care and educational institutions with shared goals to pool knowledge, monies, and labor toward health care education throughout a geographic area. This article details one Midwestern U.S. region's work in creating a professional development plan for a new simulation consortium.
Medicine Development: What’s My Responsibility?
(Wolters Kluwer, 2016-09) Bartlett Ellis, Rebecca J.; School of Nursing
Building the case for actionable ethics in digital health research supported by artificial intelligence
(Springer Nature, 2019-07-17) Nebeker, Camille; Torous, John; Bartlett Ellis, Rebecca J.; School of Nursing
The digital revolution is disrupting the ways in which health research is conducted, and subsequently, changing healthcare. Direct-to-consumer wellness products and mobile apps, pervasive sensor technologies and access to social network data offer exciting opportunities for researchers to passively observe and/or track patients ‘in the wild’ and 24/7. The volume of granular personal health data gathered using these technologies is unprecedented, and is increasingly leveraged to inform personalized health promotion and disease treatment interventions. The use of artificial intelligence in the health sector is also increasing. Although rich with potential, the digital health ecosystem presents new ethical challenges for those making decisions about the selection, testing, implementation and evaluation of technologies for use in healthcare. As the ‘Wild West’ of digital health research unfolds, it is important to recognize who is involved, and identify how each party can and should take responsibility to advance the ethical practices of this work. While not a comprehensive review, we describe the landscape, identify gaps to be addressed, and offer recommendations as to how stakeholders can and should take responsibility to advance socially responsible digital health research.
Preparing Students for Success on Examinations: Readiness Assurance Tests in a Graduate-Level Statistics Course
(Healio, 2016-01) Bartlett Ellis, Rebecca J.; Carter-Harris, Lisa; MacLaughlin, Pam; School of Nursing
Formative feedback is one way to foster students' readiness for statistics examinations. The use of Readiness Assurance Tests was examined as an educational intervention in which feedback was provided for both correct and incorrect responses in a graduate-level statistics course. Examination scores in the intervention group ( n = 56) were compared with those in a control group ( n = 42). Intervention group examination scores significantly improved from 75.92 ± 14.52 on the Readiness Assurance Test to 90.06 ± 7.06, p < .001, on the midterm, and final examination scores improved from 78.23 ± 17.29 to 85.6 ± 6.98, p = .002. Intervention group midterm scores were significantly higher than those of the control group (90.06 ± 7.06 versus 79.7 ± 11.6, p < .001); however, no differences were found between the groups on the final examination (85.35 ± 9.46 versus 85.6 ± 6.98, p = .91). Use of Readiness Assurance Tests was an effective modality to increase student self-efficacy, learning experience, and, relative to a control group, midterm examination performance in statistics
Using National Measures of Patients' Perceptions of Health Care to Design and Debrief Clinical Simulations
(Wolters Kluwer, 2017-01) Eisert, Shelly L.; Bartlett Ellis, Rebecca J.; Geers, Jennifer W.; Werskey, Karen L.; School of Nursing
This article describes an innovative approach to using national measures of patients' perspectives of quality health care. Nurses from a regional simulation consortium designed and executed a simulation using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey to prepare nurses to improve care and, in turn, enhance patients' perceptions of care. The consortium is currently revising the reporting mechanism to collect data about specific learning objectives based on national quality indicator benchmarks, specifically HCAHPS. This revision reflects the changing needs of health care to include quality metrics in simulation.
Knowledge and Awareness Among Patients with Chronic Kidney Disease Stage 3
(American Nephrology Nurses Association, 2016) Welch, Janet L.; Bartlett Ellis, Rebecca J.; Perkins, Susan M.; Johnson, Cynthia S.; Zimmerman, Lani M.; Russell, Cynthia L.; Richards, Christine; Guise, David M.; Decker, Brian S.; School of Nursing
Knowledge is a prerequisite for changing behavior, and is useful for improving outcomes and reducing mortality rates in patients diagnosed with chronic kidney disease (CKD). The purpose of this article is to describe baseline CKD knowledge and awareness obtained as part of a larger study testing the feasibility of a self-management intervention. Thirty patients were recruited who had CKD Stage 3 with coexisting diabetes and hypertension. Fifty-four percent of the sample were unaware of their CKD diagnosis. Participants had a moderate amount of CKD knowledge. This study suggests the need to increase knowledge in patients with CKD Stage 3 to aid in slowing disease progression.
Behavior change interventions: the potential of ontologies for advancing science and practice
(Springer Nature, 2017-02) Larsen, Kai R.; Michie, Susan; Hekler, Eric B.; Gibson, Bryan; Spruijt-Metz, Donna; Ahern, David; Cole-Lewis, Heather; Bartlett Ellis, Rebecca J.; Hesse, Bradford; Moser, Richard P.; Yi, Jean; School of Nursing
A central goal of behavioral medicine is the creation of evidence-based interventions for promoting behavior change. Scientific knowledge about behavior change could be more effectively accumulated using "ontologies." In information science, an ontology is a systematic method for articulating a "controlled vocabulary" of agreed-upon terms and their inter-relationships. It involves three core elements: (1) a controlled vocabulary specifying and defining existing classes; (2) specification of the inter-relationships between classes; and (3) codification in a computer-readable format to enable knowledge generation, organization, reuse, integration, and analysis. This paper introduces ontologies, provides a review of current efforts to create ontologies related to behavior change interventions and suggests future work. This paper was written by behavioral medicine and information science experts and was developed in partnership between the Society of Behavioral Medicine's Technology Special Interest Group (SIG) and the Theories and Techniques of Behavior Change Interventions SIG. In recent years significant progress has been made in the foundational work needed to develop ontologies of behavior change. Ontologies of behavior change could facilitate a transformation of behavioral science from a field in which data from different experiments are siloed into one in which data across experiments could be compared and/or integrated. This could facilitate new approaches to hypothesis generation and knowledge discovery in behavioral science.

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