Effect of Physician-Pharmacist Participation in the Management of Ambulatory Cancer Pain Through a Digital Health Platform: Randomized Controlled Trial
BackgroundSelf-management of ambulatory cancer pain is full of challenges. Motivated by the need for better pain management, we developed a WeChat-supported platform, Medication Housekeeper (MediHK), to enhance communication, optimize outcomes, and promote self-management in...
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
JMIR Publications
2021-08-01
|
| Series: | JMIR mHealth and uHealth |
| Online Access: | https://mhealth.jmir.org/2021/8/e24555 |
| _version_ | 1797735808128516096 |
|---|---|
| author | Lu Zhang Howard L McLeod Ke-Ke Liu Wen-Hui Liu Hang-Xing Huang Ya-Min Huang Shu-Sen Sun Xiao-Ping Chen Yao Chen Fang-Zhou Liu Jian Xiao |
| author_facet | Lu Zhang Howard L McLeod Ke-Ke Liu Wen-Hui Liu Hang-Xing Huang Ya-Min Huang Shu-Sen Sun Xiao-Ping Chen Yao Chen Fang-Zhou Liu Jian Xiao |
| author_sort | Lu Zhang |
| collection | DOAJ |
| description |
BackgroundSelf-management of ambulatory cancer pain is full of challenges. Motivated by the need for better pain management, we developed a WeChat-supported platform, Medication Housekeeper (MediHK), to enhance communication, optimize outcomes, and promote self-management in the home setting.
ObjectiveWe conducted a randomized controlled trial to assess whether the joint physician-pharmacist team through MediHK would provide better self-management of ambulatory patients with cancer pain.
MethodsPatients were randomly assigned to either an intervention group or control group. During the 4-week study period, the pharmacist would send 24-hour pain diaries daily, adverse drug reaction (ADR) forms every 3 days, and the Brief Pain Inventory form every 15 days to patients in the intervention group via MediHK. If a patient needed a change in drug/dosage or treatment of an ADR after the comprehensive review, the pharmacist would propose pharmacological interventions to the attending physician, who was then responsible for prescribing or adjusting pain medications. If no adjustments were needed, the pharmacist provided appropriate targeted education based on knowledge deficits. Patients in the control group received conventional care and did not receive reminders to fill out the forms. However, if the control group patients filled out a form via MediHK, the pain management team would review and respond in the same way as for the intervention group. The primary outcomes included pain intensity and pain interference in daily life. Secondary outcomes included patient-reported outcome measures, medication adherence, ADRs, and rehospitalization rates.
ResultsA total of 100 patients were included, with 51 (51%) in the intervention group and 49 (49%) in the control group. The worst pain scores, least pain scores, and average pain scores in the intervention group and the control group were statistically different, with median values of 4 (IQR 3-7) vs 7 (IQR 6-8; P=.001), 1 (IQR 0-2) vs 2 (IQR 1-3; P=.02), and 2 (IQR 2-4) vs 4 (IQR 3-5; P=.001), respectively, at the end of the study. The pain interference on patients' general activity, mood, relationships with others, and interests was reduced, but the difference was not statistically significant compared with the control group (Ps=.10-.76). The medication adherence rate increased from 43% to 63% in the intervention group, compared with an increase of 33% to 51% in the control group (P<.001). The overall number of ADRs increased at 4 weeks, and more ADRs were monitored in the intervention group (P=.003). Rehospitalization rates were similar between the 2 groups.
ConclusionsThe joint physician-pharmacist team operating through MediHK improved pain management. This study supports the feasibility of integrating the internet into the self-management of cancer pain.
Trial RegistrationChinese Clinical Trial Registry ChiCTR1900023075; https://www.chictr.org.cn/showproj.aspx?proj=36901 |
| first_indexed | 2024-03-12T13:04:27Z |
| format | Article |
| id | doaj.art-77e6757d1c04422dae330559d08ea2b3 |
| institution | Directory Open Access Journal |
| issn | 2291-5222 |
| language | English |
| last_indexed | 2024-03-12T13:04:27Z |
| publishDate | 2021-08-01 |
| publisher | JMIR Publications |
| record_format | Article |
| series | JMIR mHealth and uHealth |
| spelling | doaj.art-77e6757d1c04422dae330559d08ea2b32023-08-28T18:31:44ZengJMIR PublicationsJMIR mHealth and uHealth2291-52222021-08-0198e2455510.2196/24555Effect of Physician-Pharmacist Participation in the Management of Ambulatory Cancer Pain Through a Digital Health Platform: Randomized Controlled TrialLu Zhanghttps://orcid.org/0000-0001-8567-508XHoward L McLeodhttps://orcid.org/0000-0002-9004-9232Ke-Ke Liuhttps://orcid.org/0000-0003-3969-8808Wen-Hui Liuhttps://orcid.org/0000-0001-8314-6088Hang-Xing Huanghttps://orcid.org/0000-0003-4995-2494Ya-Min Huanghttps://orcid.org/0000-0002-5777-5865Shu-Sen Sunhttps://orcid.org/0000-0001-9014-7329Xiao-Ping Chenhttps://orcid.org/0000-0002-2910-9152Yao Chenhttps://orcid.org/0000-0001-7231-9860Fang-Zhou Liuhttps://orcid.org/0000-0001-8720-7319Jian Xiaohttps://orcid.org/0000-0002-4039-306X BackgroundSelf-management of ambulatory cancer pain is full of challenges. Motivated by the need for better pain management, we developed a WeChat-supported platform, Medication Housekeeper (MediHK), to enhance communication, optimize outcomes, and promote self-management in the home setting. ObjectiveWe conducted a randomized controlled trial to assess whether the joint physician-pharmacist team through MediHK would provide better self-management of ambulatory patients with cancer pain. MethodsPatients were randomly assigned to either an intervention group or control group. During the 4-week study period, the pharmacist would send 24-hour pain diaries daily, adverse drug reaction (ADR) forms every 3 days, and the Brief Pain Inventory form every 15 days to patients in the intervention group via MediHK. If a patient needed a change in drug/dosage or treatment of an ADR after the comprehensive review, the pharmacist would propose pharmacological interventions to the attending physician, who was then responsible for prescribing or adjusting pain medications. If no adjustments were needed, the pharmacist provided appropriate targeted education based on knowledge deficits. Patients in the control group received conventional care and did not receive reminders to fill out the forms. However, if the control group patients filled out a form via MediHK, the pain management team would review and respond in the same way as for the intervention group. The primary outcomes included pain intensity and pain interference in daily life. Secondary outcomes included patient-reported outcome measures, medication adherence, ADRs, and rehospitalization rates. ResultsA total of 100 patients were included, with 51 (51%) in the intervention group and 49 (49%) in the control group. The worst pain scores, least pain scores, and average pain scores in the intervention group and the control group were statistically different, with median values of 4 (IQR 3-7) vs 7 (IQR 6-8; P=.001), 1 (IQR 0-2) vs 2 (IQR 1-3; P=.02), and 2 (IQR 2-4) vs 4 (IQR 3-5; P=.001), respectively, at the end of the study. The pain interference on patients' general activity, mood, relationships with others, and interests was reduced, but the difference was not statistically significant compared with the control group (Ps=.10-.76). The medication adherence rate increased from 43% to 63% in the intervention group, compared with an increase of 33% to 51% in the control group (P<.001). The overall number of ADRs increased at 4 weeks, and more ADRs were monitored in the intervention group (P=.003). Rehospitalization rates were similar between the 2 groups. ConclusionsThe joint physician-pharmacist team operating through MediHK improved pain management. This study supports the feasibility of integrating the internet into the self-management of cancer pain. Trial RegistrationChinese Clinical Trial Registry ChiCTR1900023075; https://www.chictr.org.cn/showproj.aspx?proj=36901https://mhealth.jmir.org/2021/8/e24555 |
| spellingShingle | Lu Zhang Howard L McLeod Ke-Ke Liu Wen-Hui Liu Hang-Xing Huang Ya-Min Huang Shu-Sen Sun Xiao-Ping Chen Yao Chen Fang-Zhou Liu Jian Xiao Effect of Physician-Pharmacist Participation in the Management of Ambulatory Cancer Pain Through a Digital Health Platform: Randomized Controlled Trial JMIR mHealth and uHealth |
| title | Effect of Physician-Pharmacist Participation in the Management of Ambulatory Cancer Pain Through a Digital Health Platform: Randomized Controlled Trial |
| title_full | Effect of Physician-Pharmacist Participation in the Management of Ambulatory Cancer Pain Through a Digital Health Platform: Randomized Controlled Trial |
| title_fullStr | Effect of Physician-Pharmacist Participation in the Management of Ambulatory Cancer Pain Through a Digital Health Platform: Randomized Controlled Trial |
| title_full_unstemmed | Effect of Physician-Pharmacist Participation in the Management of Ambulatory Cancer Pain Through a Digital Health Platform: Randomized Controlled Trial |
| title_short | Effect of Physician-Pharmacist Participation in the Management of Ambulatory Cancer Pain Through a Digital Health Platform: Randomized Controlled Trial |
| title_sort | effect of physician pharmacist participation in the management of ambulatory cancer pain through a digital health platform randomized controlled trial |
| url | https://mhealth.jmir.org/2021/8/e24555 |
| work_keys_str_mv | AT luzhang effectofphysicianpharmacistparticipationinthemanagementofambulatorycancerpainthroughadigitalhealthplatformrandomizedcontrolledtrial AT howardlmcleod effectofphysicianpharmacistparticipationinthemanagementofambulatorycancerpainthroughadigitalhealthplatformrandomizedcontrolledtrial AT kekeliu effectofphysicianpharmacistparticipationinthemanagementofambulatorycancerpainthroughadigitalhealthplatformrandomizedcontrolledtrial AT wenhuiliu effectofphysicianpharmacistparticipationinthemanagementofambulatorycancerpainthroughadigitalhealthplatformrandomizedcontrolledtrial AT hangxinghuang effectofphysicianpharmacistparticipationinthemanagementofambulatorycancerpainthroughadigitalhealthplatformrandomizedcontrolledtrial AT yaminhuang effectofphysicianpharmacistparticipationinthemanagementofambulatorycancerpainthroughadigitalhealthplatformrandomizedcontrolledtrial AT shusensun effectofphysicianpharmacistparticipationinthemanagementofambulatorycancerpainthroughadigitalhealthplatformrandomizedcontrolledtrial AT xiaopingchen effectofphysicianpharmacistparticipationinthemanagementofambulatorycancerpainthroughadigitalhealthplatformrandomizedcontrolledtrial AT yaochen effectofphysicianpharmacistparticipationinthemanagementofambulatorycancerpainthroughadigitalhealthplatformrandomizedcontrolledtrial AT fangzhouliu effectofphysicianpharmacistparticipationinthemanagementofambulatorycancerpainthroughadigitalhealthplatformrandomizedcontrolledtrial AT jianxiao effectofphysicianpharmacistparticipationinthemanagementofambulatorycancerpainthroughadigitalhealthplatformrandomizedcontrolledtrial |