My MediHealth: A Paradigm for Children-Centered Medication Management

Medication management of children with chronic conditions is complex because of the need to tailor dosages to a child’s age, weight, and development, and because of the likelihood that such children have multiple caregivers. This project addressed medication management in the pediatric population—particularly children with asthma—through further development of MyMediHealth (MMH). MMH is a mobile personal health application for medication management that was built to interface and share information with personal health records (PHRs). The overarching goal of this project was to use text messaging reminders to assess the impact of personal medication management tools on medication adherence in adolescents with asthma.

The specific aims of this project were to:

• Develop an information and scheduling knowledge base for common pediatric asthma medications (including allergy medications). 
• Adapt MyMediHealth in its current prototype form to patients diagnosed with asthma. 
• Integrate MyMediHealth into the Vanderbilt patient portal to support medication scheduling and the creation of medication reminders. 
• Evaluate the impact of MyMediHealth on medication adherence.

Ninety-eight children and their parents were randomized to receive either access to the MMH Web site or standard therapy and education. The Web site allowed users to create medication schedules and generate text message reminders about their medications. At baseline and 3 weeks, each group was assessed for symptom frequency, rescue inhaler use, and self-reported medication adherence. In addition, a sample of families in the intervention group received a home visit by a member of the project team to assess the home environment, allowing for a more in-depth understanding of barriers to medication adherence and intended use of the MMH.

At baseline, there were no significant differences between the two groups. Of those in the intervention group, 87 percent signed into MMH, but only half showed any activity on the site. Twenty-four of 46 participants in the intervention group exchanged at least one text message recorded in the system usage log (“users”). A significant improvement in the intervention group’s medication adherence was observed, although no change in asthma control was noted between the two groups. Quality-of-life and self-efficacy measures showed mild improvement in the intervention group.

Initially, the project team planned to integrate MMH into the Vanderbilt patient portal. However, security concerns from the risk management team at the university prevented this integration from taking place during the project period. MMH was therefore developed to have the ability to interface with any PHR, not specifically to the Vanderbilt system.

The project showed that use of PHR-based and text messaging tools can promote improved asthma medication management in adolescents by integrating a simple reminder system into daily routines. These systems have the potential to support a variety of individuals varying in age and chronic illness, and can be extended for use into tools beyond medication adherence.