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      Treatment Adherence in Chronic Conditions during Ageing: Uses, Functionalities, and Cultural Adaptation of the Assistant on Care and Health Offline (ACHO) in Rural Areas

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          Abstract

          The increasingly common scenario of an ageing population is related to a rise in the prevalence of problems associated with chronic conditions and comorbidities. Polypharmacy is frequent among this population, and it is a situation that can create medication management and adherence issues. This article introduces the features and functionalities of a voice assistant (Assistant on Health and Care Offline, ACHO) that aims to facilitate treatment adherence among elderly adults. Specifically adapted for its use in rural contexts, it does not require an Internet connection. Its development consisted of two stages: a first stage of problem diagnosis, in which the classic tools of ethnographic fieldwork were used, and a second stage of design implementing methodologies developed by Ambient Assisted Living (AAL) programmes. The main design characteristic of this new digital care system is that it is adapted to the needs of its end-users. It includes features such as voice customisation and the personal identification of medication, it can be connected to other digital devices, and information is introduced and supervised by healthcare professionals. These custom features introduce a safer medication administration procedure, improve supervision strategies, and increase patients’ trust in the prescription process.

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          What is polypharmacy? A systematic review of definitions

          Background Multimorbidity and the associated use of multiple medicines (polypharmacy), is common in the older population. Despite this, there is no consensus definition for polypharmacy. A systematic review was conducted to identify and summarise polypharmacy definitions in existing literature. Methods The reporting of this systematic review conforms to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) checklist. MEDLINE (Ovid), EMBASE and Cochrane were systematically searched, as well as grey literature, to identify articles which defined the term polypharmacy (without any limits on the types of definitions) and were in English, published between 1st January 2000 and 30th May 2016. Definitions were categorised as i. numerical only (using the number of medications to define polypharmacy), ii. numerical with an associated duration of therapy or healthcare setting (such as during hospital stay) or iii. Descriptive (using a brief description to define polypharmacy). Results A total of 1156 articles were identified and 110 articles met the inclusion criteria. Articles not only defined polypharmacy but associated terms such as minor and major polypharmacy. As a result, a total of 138 definitions of polypharmacy and associated terms were obtained. There were 111 numerical only definitions (80.4% of all definitions), 15 numerical definitions which incorporated a duration of therapy or healthcare setting (10.9%) and 12 descriptive definitions (8.7%). The most commonly reported definition of polypharmacy was the numerical definition of five or more medications daily (n = 51, 46.4% of articles), with definitions ranging from two or more to 11 or more medicines. Only 6.4% of articles classified the distinction between appropriate and inappropriate polypharmacy, using descriptive definitions to make this distinction. Conclusions Polypharmacy definitions were variable. Numerical definitions of polypharmacy did not account for specific comorbidities present and make it difficult to assess safety and appropriateness of therapy in the clinical setting.
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            Qualitative research in health care: Analysing qualitative data

            C Pope (2000)
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              Interventions for enhancing medication adherence.

              People who are prescribed self administered medications typically take only about half their prescribed doses. Efforts to assist patients with adherence to medications might improve the benefits of prescribed medications.
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                Author and article information

                Contributors
                Role: Academic Editor
                Journal
                J Pers Med
                J Pers Med
                jpm
                Journal of Personalized Medicine
                MDPI
                2075-4426
                02 March 2021
                March 2021
                : 11
                : 3
                : 173
                Affiliations
                [1 ]Department of Nursing, Faculty of Nursing and Occupational Therapy, University of Extremadura, 10003 Cáceres, Spain; dcondecab@ 123456unex.es (D.C.-C.); lorenmariano@ 123456unex.es (L.M.-J.)
                [2 ]Department of Computer and Telematic Systems Engineering, Polytechnic School, University of Extremadura, 10003 Cáceres, Spain; manuel@ 123456unex.es (M.J.-A.); jgaralo@ 123456unex.es (J.G.-A.)
                [3 ]Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Health Sciences, University of Castilla La Mancha, 13071 Ciudad Real, Spain; Mariacarmen.Cipriano@ 123456uclm.es
                Author notes
                [* ]Correspondence: brivero@ 123456unex.es ; Tel.: +34-927-257-064
                Author information
                https://orcid.org/0000-0002-5967-4371
                https://orcid.org/0000-0002-3691-0968
                https://orcid.org/0000-0002-0584-8030
                https://orcid.org/0000-0003-0824-6956
                https://orcid.org/0000-0001-8483-7200
                Article
                jpm-11-00173
                10.3390/jpm11030173
                7999645
                fe43a34b-3825-490c-9081-30f8b6713442
                © 2021 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 22 January 2021
                : 25 February 2021
                Categories
                Article

                treatment adherence,chronically ill patients,voice assistant,rural,ageing

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