Assessment of the Health Related Effects of Compliance Optimization in Asthma through use of SMS

Transcription

1 Assessment of the Health Related Effects of Compliance Optimization in Asthma through use of SMS Claus Møldrup PhD (pharm.) Professor. Birthe Søndergaard Jonathan Stein University of Copenhagen Faculty of Pharmaceutical Sciences Department of Pharmacology and Pharmacotherapy Pending review.journal of Medical Internet Research (JMIR)

2 Objective to assess the health related effects of the SMS compliance system for asthma treatment through a controlled trial

3 Design

4 Patient recruitment Participants were recruited by use of the internet An invitation to participate was sent to an interest group of approximately 4000 individuals in a Netdoktor.dk newsgroup Participants were segmented and enrolled automatically by using a computerized algorithm, based on six questions

5 Inclusion and segmenting criteria Age 1845 years (3 levels) Gender (2 levels) Current selfreported asthma control (5 levels) This generated 30 different categories as a basis for segmenting the participants into homogeneous control and intervention groups Additional question: do you use a device for measuring peak flow? (This question was used to generate an additional SMS question in the intervention group)

6 Recruitment and status

7 Stratification and randomizing

8 Once assigned to the control or intervention group, the participants received a baseline questionnaire Final inclusion in the study was based on completing the baseline questionnaire in addition to the initial six questions Participants were enrolled in the study from November 2007 to April 2008 Participant were enrolled in the study for 90 days

9 Intervention 1. Remember to take your preventive asthma medication (sent at 8.00 am) 2. Were you awakened during the night due to your asthma? Answer YES or NO 3. How many times have you taken your asthma attack medication during the last 24 hours? Answer a number 4. What was your peak flow this morning? Answer a number (optional, depending on the participant s use of a peakflow meter prior to the study)

10 Questionnaires EQ5D (mobility, selfcare, usual activities, pain/discomfort, anxiety/depression) 5question asthma control test Two questions on selfreported adherence to treatment Specific asthma medication brands used Demographics (education, work position, income) Use of healthcare services (doctor calls and visits, hospitals, emergencies, doctoronduty, pharmacies, and others) Baseline, 45 days and 90 days

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12 Selfreported adherence What is the dose indicated on the label of your preventive [asthma] medication that you should take? Please select inhalations time(s) a day What dose of your preventive [asthma] medication do you actually take? Please select inhalations time(s) a day

13 Intervention The SMS sequence was delivered to the intervention group: Month 1. Daily Month 2. Every 3 days Month 3. Once weekly

14 Results included patients Intervention group n = 114 Control group n = 130 Sex Male 17 (14.9%) 22 (16.9%) Female 97 (85.1%) 108 (83.1%) Age (Mean (SD)) 34.9 (7.0) 34.5 (7.6) Use of preventive medicine (Mean (SD)) Use of health services (Mean (SD)) Selfreported asthma control (Mean (SD)) EQ5D (%) Mobility Level 1 Level 2 Level (1.9) 2.2 (2.0) 1.2 (1.8) 2.6 (5.7) 13.1 (3.6) 13.5 (3.7) Selfcare Level 1 Level 2 Level Usual activities Level 1 Level 2 Level Pain/ Discomfort Level 1 Level 2 Level Anxiety/ Depression Level 1 Level 2 Level

15 Intervention group adherence to the SMS system figur 1

16 Number of SMS send in intervention group figur 2

17 Results Baseline 2.nd Baseline 3.th Outcome measure s Baseline questionnaire Interve n = 114 Control n = 130 2nd questionnaire Interve n = 98 Control n = 96 3rd questionnaire Interve n = 92 Control n = 88 Within group diff. pvalue Between groups diff. Use of preventive 2.2 (1.9) 2.2 (2.0) 1.9 (1.7) 1.8 (2.0) 1.9 (1.9) 1.6 (1.8) 0.005/ / medicine Use of health care services Asthma control 1.2 (1.8) 13.1 (3.6) 2.6 (5.7) 1.3 (2.5) 1.3 (2.4) 1.1 (1.8) 1.1 (2.1) 0.46/ / (3.7) 12.8 (3.3) 12.7 (3.5) 12.4 (3.2) 12.6 (3.7) 0.38/ /

18 Results EQ5D Outcome measures Baseline questionnaire 2nd questionnaire 3rd questionnaire pvalue Interventi o n = 114 Control n = 130 Interventi o n = 98 Control n = 96 Interventi o n = 92 Control n = 88 Within group diff. Betwee n groups diff. Mobility / / Selfcare Activities Pain/dis comfort /> /> Anxiety Depression / / / /

19 Selfreported compliance Non Compliant Compliant Total Control group 65 (50%) 65 (50%) 130 Intervention group 42 (36,8%) 72 (63,2%) 114 Total 107 (43,9%) 137 (56,1%) P=0,039

20 Results Patient satisfaction N=58 Mean Minmax I would have preferred a better introduction It was easy to participate in the study It was difficult to answer SMS I was surprised by the feedback results I feel better after using the system The SMS was annoying in the end The SMS service should be free and paid for by the government 1,66 4,84 1,26 2,38 3,31 2,60 3,

21 Conclusion SMS is a reliable, convenient, affordable, secure, and feasible technology to use as a medium for communication between the patient and the healthcare system Compliance was improved No improvement in use of medicine No improvement in asthma control No reductions in contacts with the healthcare system