Technical and Behavioral Interventions for Medication Adherence through Mobile Health

In this research, we present a novel intervention, Carrot and Stick, to improve the outcome of one of the self-management tasks, medication adherence (MA), among patients with chronic disease(s). Our design incorporates the growing importance of mobile health (m-health) in Health Information Technology (HIT) with the users’ dependency on mobile phones to facilitate valuable behavioral changes. Drawing on Social Cognitive Theory, Social Exchange Theory, Goal-setting Theory, and people’s dependence on smartphones, we develop the functionalities in our intervention, including positive and negative reinforcement, goal-setting, and social connections. The iterative process of our development follows the Design Science Approach. In the evaluation and validation of our intervention, we not only examine the intervention’s impacts on patients through analytical models and simulation but also demonstrate the possible active support of the intervention from healthcare providers based on the current pay-for-performance (P4P) scheme. Our results suggest that (1) with the help of electronic medication container, appropriate reminder design can reduce the patients’ chances of forgetting doses, overdosing, and intaking doses at the wrong time, (2) positive reinforcement can help increase the probability of the patient achieving expected MA, while negative reinforcement has a further impact that is added to the increment, (3) our intervention can assist the patient in saving more than $600 per year, and (4) under the current P4P scheme, physicians with the exceptional performance or with bad performance are likely to invest in the intervention to change their patients’ behaviors, while physicians with good performance are less likely to participate. Our research is the first to utilize negative reinforcement in intervention design to enhance MA; it is also the first to provide corresponding interventional solutions that are customized according to elements derived from theories. Besides, the focus and understanding of healthcare providers’ involvement in the incentive program can facilitate the adoption, prescription, and implementation of the proposed intervention

Mobile phone intervention for increasing adherence to treatment for type 2 diabetes in an urban area of Bangladesh: protocol for a randomized controlled trial

BACKGROUND: Mobile phone technologies including SMS (short message service) have been used to improve the delivery of health services in many countries. However, data on the effects of mobile health technology on patient outcomes in resource-limited settings are limited. The aim of this study therefore is to measure the impact of a mobile phone SMS service on treatment success of newly diagnosed type 2 diabetes in an urban area of Bangladesh. METHODS/DESIGN: This is a single-centred randomized controlled intervention trial (prospective) comparing standard-of-care with standard-of-care plus a mobile phone-based SMS intervention for 6&nbsp;months. A total of 216 participants with newly diagnosed type 2 diabetes will be recruited. Data will be collected at the outpatient department of Bangladesh Institute of Health Science (BIHS) hospital at baseline and after 6&nbsp;months. The primary outcome measure will be change in HbA1c between baseline and 6&nbsp;months. The secondary outcome measures are self-reported medication adherence, clinic attendance, self-reported adoption of healthy behaviours, diabetes knowledge, quality of life and cost effectiveness of the SMS intervention. The inclusion criteria will be as follows: diagnosed as patients with type 2 diabetes by the BIHS physician, using oral medication therapy, living in Dhaka city, registered with the BIHS hospital, using a mobile phone, willing to return for follow up after 6&nbsp;months and providing written informed consent. Participants will be allocated to control and intervention arms after recruitment using a randomization software. Data will be collected on socio-demographic and economic information, mobile phone use and habits, knowledge of prevention, management and complications of diabetes, self-perceived quality of life assessment, self-reported diseases, medical history, family history of diseases, medication history, medication adherence, health seeking behaviour, tobacco use, physical activity, diet, mental health status, life events and disability, anthropometric measurements of weight, height, blood pressure and blood tests for HbA1c. DISCUSSION: Mobile phone SMS services have the potential to communicate with diabetes patients and to build awareness about the disease, improve self-management and avoid complications also in resource-limited setting. If this intervention proves to be efficient and cost-effective in the current trial, large-scale implementation could be undertaken.<br /

Effects of and satisfaction with short message service reminders for patient medication adherence: a randomized controlled study

BACKGROUND: Medication adherence is critical for patient treatment. This study involved evaluating how implementing Short Message Service (SMS) reminders affected patient medication adherence and related factors. METHODS: We used a structured questionnaire to survey outpatients at three medical centers. Patients aged 20 years and older who were prescribed more than 7 days of a prescription medication were randomized into SMS intervention or control groups. The intervention group received daily messages reminding them of aspects regarding taking their medication; the control group received no messages. A phone follow-up was performed to assess outcomes after 8 days. Data were collected from 763 participants in the intervention group and 435 participants in the control group. RESULTS: After participants in the intervention group received SMS reminders to take medication or those in the control group received no messages, incidences of delayed doses were decreased by 46.4 and 78.8% for those in the control and intervention groups, respectively. The rate of missed doses was decreased by 90.1% for participants in the intervention group and 61.1% for those in the control group. We applied logistic regression analysis and determined that participants in the intervention group had a 3.2-fold higher probability of having a decrease in delayed doses compared with participants in the control group. Participants in the intervention group also showed a 2.2-fold higher probability of having a decrease in missed doses compared with participants in the control group. CONCLUSIONS: Use of SMS significantly affected the rates of taking medicine on schedule. Therefore, daily SMS could be useful for reminding patients to take their medicine on schedule

Empowering Diabetes Patient with Mobile Health Technologies

Chronic diseases, especially diabetes mellitus, are huge public health burden. Therefore, new health care models for sharing the responsibility for care among health care providers and patients themselves are needed. The concept of empowerment promotes patient’s active involvement and control over their own health. It can be achieved through education, self-management, and shared decision making. All these aspects can be covered by mobile health technologies, the so-called mHealth. This term comprises mobile phones, patient monitoring devices, tablets, personal digital assistants, other wireless devices, and numerous apps. Many challenges of diabetics can be addressed by mHealth, including glycemic control, nutrition control, physical activity, high blood pressure, medication adherence, obesity, education, diabetic retinopathy screening, diabetic foot screening, and psychosocial care. However, mHealth plays only minor role in diabetes management, despite numerous apps on the market. Namely, these apps have many shortcomings and the majority of them does not include important functions. Moreover, these apps lack the perceived additional benefit by the user and the ease of use, important factors for acceptance of mHealth. Studies of diabetes apps regarding usability and accessibility have shown moderate results. Beside improvements of apps usability, the future of diabetes mHealth lies probably in personalized education and self-management with the help of decision support systems. At the same time, work on artificial pancreas is in progress and smartphone could be used as user interface

Perspectives of patients on outpatient parenteral antimicrobial therapy: Experiences and adherence

Background: Nonadherence to medication is a burden to the US health care system and is associated with poor clinical outcomes. Data on outpatient parenteral antimicrobial therapy (OPAT) treatment plan adherence are lacking. The purpose of this study is to determine the rate of nonadherence and factors associated with it. Methods: We surveyed patients discharged from a tertiary hospital on OPAT between February and August 2019 about their baseline characteristics, OPAT regimen, adherence, and experience with OPAT. Results: Sixty-five patients responded to the survey. The median age was 62 years, and 56% were male. The rate of reported nonadherence to intravenous (IV) antibiotics was 10%. Factors associated with nonadherence to IV antibiotics included younger age, household income of \u3c$20 Conclusions: Less frequent antibiotic dosing and better social support were associated with improved adherence to OPAT. In contrast, younger age, lower income, and lack of time were associated with nonadherence

Telephone support and adherence in patients with chronic disease:A qualitative review of reviews

Divya Balasubramanian,1 Joanne Yoong,1&ndash;3 Hubertus JM Vrijhoef1,3&ndash;6 1Saw Swee Hock School of Public Health, National University Singapore, Singapore; 2Center for Economic and Social Research, University of Southern California, California, USA; 3Center for Health Services and Policy Research, National University Health System, Singapore; 4Scientific Center for Care and Welfare, Tilburg University, Tilburg, The Netherlands; 5Department of Patients &amp; Care, Maastricht University Medical Center, Maastricht, The Netherlands; 6Department of Family Medicine and Chronic Care, Vrije Universiteit Brussels, Brussels, Belgium Abstract: Among patients with a chronic disease, low adherence to prescribed treatments is very common, leading to substantial morbidity, mortality, and increase in health care costs. Telephone or mobile phone support is a common form of intervention that can be used to improve their adherence. We reviewed existing systematic and nonsystematic reviews to analyze the effectiveness of telephone interventions to improve treatment adherence in patients with chronic disease. Secondary aims were to evaluate the selected reviews in terms of cost-effectiveness of the intervention and frequency of messages affecting the adherence outcomes. A search for reviews was conducted in three databases, including PubMed, the Cochrane Library, and CINAHL, and three reviews that met the inclusion criteria were selected for final analysis. A qualitative review of the selected reviews was conducted, and reviews were evaluated to extract and summarize the characteristics and outcomes. Two of the selected reviews studied mobile phone text messaging, and one review studied telephone or mobile phone consultation. All three reviews reported an overall improvement in adherence, but the reviews varied in the types of research and the outcome measures. However, none of the reviews reported costs as an outcome. The evidence from reviews to characterize the effectiveness or cost-effectiveness of telephone support as an intervention to improve adherence among people with chronic diseases is fairly small and weak. Telephone support interventions have to be evaluated more systematically in routine practice against a comprehensive set of criteria, including their relative costs and outcomes. Keywords: literature review, compliance, telemedicine, communicable diseases, cost-effectivenes

E-Monitoring of Asthma Therapy to Improve Compliance in children using a real-time medication monitoring system (RTMM): The e-MATIC study protocol

Background: Many children with asthma do not have sufficient asthma control, which leads to increased healthcare costs and productivity loss of parents. One of the causative factors are adherence problems. Effective interventions improving medication adherence may therefore improve asthma control and reduce costs. A promising solution is sending real time text-messages via the mobile phone network, when a medicine is about to be forgotten. As the effect of real time text-messages in children with asthma is unknown, the primary aim of this stud