Efficacy of ScripTalk Automated Prescription Label Reader and Veterans with Visual Impairments

Visual decline is one of the most prominent features of age-related disability among older adults. In 2012, more than 20.6 million American adults reported vision loss (Blackwell, Lucas, & Clarke, 2012), and worldwide, according to the World Health Organization (2014), more than 285 million people are estimated to have visual impairment. Individuals with visual impairments are affected by significant psychosocial stressors, functional limitations, and increased mortality (Kempen, Ballemans, Ranchor, van Rens, & Zijlstra, 2012). Studies have shown that older individuals with visual impairments have diminished ability to perform activities of daily living (Knudtson, Klein, Klein, Cruickshanks, & Lee, 2005), and demonstrate poor health and increased disability (Crews, Chou, Zhang, Zack, & Saaddine, 2014). Furthermore, individuals with vision loss are often socially isolated (Alma et al., 2011), and have increased levels of psychological distress, anxiety, and depression (Kempen et al., 2012; Rovner, Zisselman, & Shmuely-Dulitzki, 1996). Although studies have shown a relationship between vision loss and depression, Rovner et al. (2014) demonstrated that the combination of mental health treatments and low vision interventions halved the incidence of depressive disorders relative to standard low vision interventions alone in individuals with macular degeneration. Furthermore, there is a correlation between visual impairment and increased mortality (Jacobs, Hammerman-Rozenberg, Maaravi, Cohen, & Stessman, 2005; Christ, Lee, Lam, Zheng, & Arheart, 2008; McCarty, Nanjan, & Taylor, 2001; Cacciatore et al., 2004). Compared to individuals with hearing deficits, individuals with vision loss have higher morbidity and are more likely to suffer from diabetes mellitus, heart disease, and hypertension (Crews & Campbell, 2004; Crews, Jones, & Kim, 2006). Notably, an association has been identified between visual impairment and an increased risk of hospitalization, which is likely secondary to the reduced functional ability associated with visual impairment and other comorbidity (Evans, Smeeth, & Fletcher, 2008). It is noteworthy that reading prescription labels and self-administering the correct drug and dosage at correct intervals requires a level of vision that most individuals with visual disabilities are incapable of, even with appropriate optical or auxiliary aids. Studies have suggested that medication mismanagement may be related to vision loss (American Foundation for the Blind, 2008; Murray, Darnell, Weinberger, & Martz, 1986; Smith & Bailey, 2014). The American Foundation for the Blind in 2008 reported that individuals with visual impairments lack access to critical medication use instructions. Common negative consequences of visual impairment include not taking medications at proper dosages or mistakenly taking expired or incorrect medications (American Foundation for the Blind, 2008; Smith & Bailey, 2014). As shown previously, difficulty with medication adherence can cause detrimental health consequences (McCann et al., 2012; Gellad, Grenard, & Marcum, 2011; Hughes, 2004). Prior studies have noted that individuals with visual impairments are more than twice as likely to need help managing their medication compared to individuals with typical vision (McCann et al., 2012). Therefore, it is important to minimize barriers that impair proper adherence to medication regimens. [FIGURE 1 OMITTED] One medication-use device that is widely employed within the Department of Veterans Affairs is ScripTalk, created by Envision America (2014), an audible prescription reader that uses radio-frequency identification and text-to-speech technology to "speak" the prescription label to the user (Figure 1). The ScripTalk computer software can be used by a pharmacy to encode a microchip located in the prescription label with pertinent information, including the medication's name, proper dosage, side effects, warnings, and pharmacy name and telephone number. …