6.3 – facilitating medication adherence and eliminating therapeutic inertia using wireless...
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Wednesday, October 24, 2012 Technical Session #6 John W McGillicuddy (Medical University of South Carolina, US), Mathew J Gregoski (Medical University of South Carolina, US), Brenda M Brunner-Jackson (Medical University of South Carolina, US), Ana K Weiland (Medical University of South Carolina, US), Sachin K Patel (Medical University of South Carolina, US), Rebecca A Rock (College of Charleston, US), Eveline M Treiber (College of Charleston, US), Lydia K Davidson (College of Charleston, US), Frank A Treiber (Medical University of South Carolina, US)TRANSCRIPT
Facilitating Medication Adherence & Eliminating Therapeutic Inertia Using
Wireless Technology: Proof of Concept Findings with Uncontrolled Hypertensives &
Kidney Transplant Patients
SubtitlePresenters
Date
John W McGillicuddy, MD,Mathew Gregoski, PhD. ,Brenda Brunner
Jackson, MPH, Ana Weiland, BS, Sachin Patel, MS, Rebecca Rock, Eveline Treiber, Lydia
Davidson & Frank Treiber, PhD. Presented: Wireless Health 2012 ; San Diego, Ca. ,10/24/12
Background What unmet healthcare needs are we addressing? Effective programs for chronic disease management:
• Patient non-adherence to medication regimens • Therapeutic inertia(failure to respond in timely
manner to clinical data) What is take away message ? Theory based, patient & provider guided, SOC validated, mHealth self management programs are viable solutions
BackgroundMedication adherence: extent prescribed dose,Frequency, & timing of regimen followed 50% of patients adhere to medication regimens
Med non-adherence leads to: Suboptimal clinical outcomes Reduced work force productivity Increased healthcare costs $100-300 Billion/yr
http://sctr.musc.edu843-792-8300
Background mHealth Viable Solution
~ 20,000 chronic disease management & health /wellness apps (Apple Marketplace : 95 HTN; 242BP)
Majority appear to have not been developed using theory based, patient/provider centered, data driven, iterative approach
Healthcare providers seek validated effective programs following SOC guidelines (FDA approval, Happtique –clearing house)
http://sctr.musc.edu843-792-8300
http://sctr.musc.edu843-792-8300
Purpose Incorporate theory driven, patient & provider
centered, iterative model for devpt of mHealth self management programs
MRC’s Update on Guidance for Devpt of Complex Interventions
Utilize it in 2 proof of concept RCTs
http://sctr.musc.edu843-792-8300
Iterative Design Model
Problem Selecting
Observing
Refra
min
g an
d Ac
com
mod
ating
Solution Finding
Converging
Experimenting
Diverging
Lit Review; theory selection
Interview focus group. (Barriers, poss approaches)
Surveys(n=99; 80)
SMASH devpt
Feasibility trialPOC trial
Efficacy/effectiveness trial
Personalized Feedback Development
http://sctr.musc.edu843-792-8300
Participants Uncontrolled Hypertensives 6 Hispanics (low SES, rural, farmers)
• Prescribed 1-2 meds but not taking any 6 Kidney transplant patients (3 AAs, 2 Ws, 1 H)
• 3 mths post transplant• 8-10 meds(bid; tid)• 1 month adherence <.85
http://sctr.musc.edu843-792-8300
Methods Clinic Evaluations :
• Resting BP: Pre-intervention 1,2, & 3 mths • 24 hr BP: Pre-intervention & 3 mths
2 Arm RCT: SMASH vs SOC:• Maya MedMinder• Bluetoothed Fora D15b BP/glucometer
and A&D UA-767 PBT BP monitor• Android phone-data transmission, immed. feedback & personalized messages
SMASH (BP/Glucose) Control ProgramBased upon Self Determination Theory & Patient Centered Iterative Stage Devpt.
Share data with EMR. Automated summary reports and alerts to clinician.
Automated Personalized Messages
SMASH Workflow Model
http://sctr.musc.edu843-792-8300
Results Hispanic POC 100% recruitment & retention rates Med adherence of .96 over 3 mths
Resting SBP across 3-months by Intervention Group
SBPpre SBP3mo DBPpre DBP3mo60
70
80
90
100
110
120
130
140
150151.28
122.74
98.13
78.22
140.19 139.56
79.683.4
24-Hr. ABP
SMASH SOC
SB
P|D
BP
(mm
Hg
)
24 Hour SBP and DBP at Pre-Intervention and Trial Completion by Intervention Group
SMASH -meds changed twice vs none in SOC
http://sctr.musc.edu843-792-8300
Results cont. Kidney Transplant Patients POC 100% recruitment & retention rates 6/8 < 85% adherence during 1 mth screening SMASH-meds changed twice vs none in SOC
Medication Adherence Rates* Group Screening 1 mth 2 mth
SMASH 69.8 93.4 96.2 SOC 54.5 42.7 57.5
*Russell et al (2010) algorithm (eg, bid: .5 within 90min; .25 within 3hrs )
http://sctr.musc.edu843-792-8300
Results cont.
Pre 1 2 3 4 5 6130
140
150
160
148.67
139.67
133.67
140.50
150.50 150.00
SMASH SOC
Months Intervention
SB
P (
mm
Hg
)
Clinical Hypertension
Kidney Transplant Patients Resting SBP Changes
http://sctr.musc.edu843-792-8300
Discussion SMASH had high patient & provider acceptability Significant & sustained med adherence achieved Sustained BP control achieved (resting BP <140/90;
24 hr BP < 135/80 mmHg), not typically achieved in previous trials
Indications that SDT constructs achieved (self efficacy & intrinsic motivation) based upon 3 mth follow up
Theory guided, iterative patient –provider centered model adaptable to other mHealth patient self management paradigms
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http://sctr.musc.edu843-792-8300
Thank you
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