BackgroundPsychiatric prescribers typically assess adherence by patient or caregiver self-report. A new digital medicine (DM) technology provides objective data on adherence by using an ingestible event monitoring (IEM) sensor embedded within oral medication to track ingestion. Despite likely clinical benefit, adoption by prescribers will in part depend on attitudes toward and experience with digital health technology, learning style preference (LSP), and how the technology s utility and value are described.Objectiveis to identify attitudes, experiences, and proclivities toward DM platforms that may affect adoption of the IEM platform and provide direction on tailoring educational materials to maximize adoption. Methods A survey of prescribers treating seriously mentally ill patients was conducted to assess drivers/barriers to IEM adoption. Factor analysis was performed on 13 items representing prior experience with and attitudes toward DM. Factor scores were correlated with prescriber characteristics including attitude and experience with digital technologies, LSP, and level of focus on healthcare cost.ResultsA total of 127 prescribers (56% female, 76% physicians, mean age 48.1yrs.) completed the survey. Over 90% agreed medication adherence is important, visits allow enough time to monitor adherence (84.1%), and tailoring treatment to level of adherence would be beneficial (92.9%). The majority (65.9%) preferred relying upon outcomes data as their learning style while 15.9% preferred opinion leader recommendations and 18.3% information about how the technology would affect practice efficiency. Factor analysis revealed four dimensions: Level of comfort with EHR; Concern over current ability to monitor medication adherence; Attitudes about value of DM applications; and Benefits vs cost of DM for payers. Women scored higher on attitudes about the value of digital applications (p<0.01). Providers who perceive non-adherence as costly, and those who believe DM could benefit providers and patients scored higher on the value of DM (p<.05). Those whose LSP focuses on improving efficiency and prescribers with a higher proportion of Medicaid/ uninsured patients displayed concern about their ability to monitor adherence (p<0.05). Willingness to be a Beta Test site for DM applications was positively correlated with concern about their ability to monitor adherence and attitudes about the value of DM (p <0.01).ConclusionsPrescriber characteristics including LSP, focus on healthcare costs, and attitudes toward DM may be related to adoption of the IEM platform. Those with more Medicaid/ uninsured patients were more concerned about ability to monitor adherence while those focused-on cost and benefit to providers and patients viewed DM as part of a solution for managing outcomes and cost. Overall, LSP, patient panel size by payer type, and focus on healthcare cost containment should be considered when developing IEM provider training materials.FundingOtsuka Pharmaceutical Development & Commercialization, Inc.

中文翻译：

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精神科处方者对数字医学的态度、经验和倾向以及它们如何影响数字医学平台的采用

背景精神科医师通常通过患者或护理人员的自我报告来评估依从性。一种新的数字医学 (DM) 技术通过使用嵌入口服药物中的可摄入事件监测 (IEM) 传感器来跟踪摄入，从而提供有关依从性的客观数据。尽管可能有临床益处，但处方者的采用将部分取决于对数字健康技术的态度和经验、学习风格偏好 (LSP) 以及如何描述该技术的实用性和价值。目标是确定对数字健康技术的态度、经验和倾向DM 平台可能会影响 IEM 平台的采用，并为定制教育材料提供指导以最大限度地提高采用率。方法 对治疗严重精神病患者的处方者进行了调查，以评估采用 IEM 的驱动因素/障碍。对代表先前对 DM 的经验和态度的 13 个项目进行因素分析。因素得分与处方者特征相关，包括对数字技术的态度和经验、LSP 以及对医疗保健成本的关注程度。结果共有 127 名处方者（56% 女性，76% 医生，平均年龄 48.1 岁）完成了调查。超过 90% 的同意服药依从性很重要，访问允许有足够的时间来监测依从性 (84.1%)，根据依从性水平调整治疗将是有益的 (92.9%)。大多数人 (65.9%) 更喜欢将结果数据作为他们的学习方式，而 15.9% 的人更喜欢意见领袖的建议，18.3% 的人更喜欢关于技术将如何影响实践效率的信息。因素分析揭示了四个维度： EHR 的舒适度；对目前监测药物依从性的能力的担忧；对 DM 应用价值的态度；付款人的 DM 福利与成本。女性对数字应用价值的态度得分较高（p<0.01）。将不依从性视为代价高昂的提供者，以及认为 DM 可以使提供者和患者受益的提供者在 DM 的价值上得分较高 (p<.05)。那些 LSP 专注于提高效率的人以及拥有较高比例的医疗补助/未保险患者的处方者对他们监测依从性的能力表示担忧 (p<0.05)。愿意成为 DM 应用程序的 Beta 测试站点与关注其监控依从性的能力和对 DM 价值的态度的关注呈正相关（p <0.01）。结论处方特征包括 LSP、关注医疗保健成本、对 DM 的态度可能与采用 IEM 平台有关。那些拥有更多医疗补助/无保险患者的人更关心监测依从性的能力，而那些关注提供者和患者的成本和收益的人将 DM 视为管理结果和成本的解决方案的一部分。总体而言，在开发 IEM 提供者培训材料时，应考虑 LSP、按付款人类型划分的患者小组规模以及对医疗保健成本控制的关注。FundingOtsuka Pharmaceutical Development & Commercialization, Inc.