Real Time Medication Monitoring with tailored SMS reminders improves adherence to oral
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1 Real Time Medication Monitoring with tailored SMS reminders improves adherence to oral antidiabetic medication M. Vervloet 1, L. van Dijk 1, A.G. Wormgoor 2, J. Santen-Reestman 2, D.H. de Bakker 1,3, M.L. Bouvy 4 1 NIVEL, Netherlands institute for health services research; 2 Mediq Pharmacies; 3 Tranzo, Scientific centre for care and welfare, Tilburg University; 4 Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University
2 Background In 2007: patients in The Netherlands diagnosed, 90% with type 2 diabetes (T2DM) Treatment T2DM aimed at achieving glycemic control One of key strategies: long-term therapy with oral antidiabetics Medication adherence: 36%-93%
3 Background continued Innovative: reminding patients of their medication intake (reminder packaging, audiovisual reminders and now SMS) Real Time Medication Monitoring (RTMM): possibility of reminding per SMS only if necessary
4 Real Time Medication Monitoring The dispenser sends a message to the central server each time it is opened If the dispenser is not opened at the right time, a text message (SMS) is sent to the patient Data about medication use is available for both patient and care provider Every medication intake is registered in real time patient tailored SMS reminders
5 Objective & design Evaluate effects of RTMM with tailored SMS reminders on adherence to oral antidiabetics Randomised Controlled Trial, 3 arms: - SMS : 6 months use of dispenser with SMS reminders and personal website - non-sms : 6 months use of dispenser only - Control : usual care
6 Participants Inclusion criteria: Use of oral antidiabetics > 1 year; Refill adherence < 80%; Age years; Knowledge of Dutch language; Use of mobile phone. Setting: 40 Mediq Pharmacies, 605 eligible patients Included (n=161): SMS: n=56, non-sms: n=48, control: n=57
7 Flowchart Automatic selection of patients with search in database Mediq (pharmacy data) Manual selection of patients based on (anonymous) pharmacy data Randomisation of patients per pharmacy Pharmacies N=40 SMS non-sms Control Data Questionnaire Pharmacy data Medication intake as registered with RTMM INCLUSION PATIENTS PRETEST INTERVENTION Duration: 6 months Questionnaire Pharmacy data Pharmacy data POSTTEST FOLLOW-UP 5 months after intervention
8 Outcome measure Adherence to oral antidiabetics, defined as: 1) Refill adherence (based on pharmacy data) 2) Proportion of missed doses (based on RTMM data) 3) Proportion of doses taken within four standardized time windows (based on RTMM data)
9 Examples registered data RTMM 4:00 6:00 8:00 10:00 12:00 14:00 16:00 18:00 20:00 22:00 0:00 6:00 0:00 2:00 4:00 4-sep sep sep-08 4-okt okt okt-08 3-nov nov nov-08 3-dec dec dec-08 2-jan jan jan-09 1-feb feb feb-09 3-mrt mrt mrt-09 6:00 8:00 10:00 12:00 14:00 16:00 18:00 20:00 22:00 0:00 2:00 4:00 23-nov nov-08 7-dec dec dec dec-08 4-jan jan jan jan-09 1-feb-09 8-feb feb feb-09 1-mrt-09 8-mrt mrt mrt mrt-09 5-apr apr apr apr-09 3-mei mei mei mei mei-09
10 Characteristics participants SMS (n=56) non-sms (n=48) Control (n=57) Age (years), mean±sd 54.9± ± ±7.8 Male, n (%) 31 (55.4) 26 (54.2) 28 (49.1) Ethnicity, n (%) - native Dutch 29 (51.8) 26 (54.2) 39 (68.4) - Western immigrant 3 (5.4) 2 (4.2) 6 (10.5) - non-western immigrant 15 (26.8) 12 (25.0) 12 (21.1) Daily regimen, n (%) One dose 11 (19.6) 12 (25.0) 13 (22.8) Two doses 25 (44.6) 27 (56.3) 24 (43.9) Three doses 20 (35.7) 9 (18.8) 19 (33.3)
11 SMS vs. non-sms vs. control Mean refi ill adherence (%) baseline * follow-up NS ** RTMM+ RTMM- control No significant differences at baseline (approx. 62%) * p=0.014 (SMS vs. non-sms) ** p= (SMS vs. control) NS: p=0.128 (non-sms vs. control)
12 SMS vs. non-sms Average % of missed doses SMS (n=56): 14.5% (SD=11.7) non-sms (n=48): 19.2% (SD=16.2) p=0.065 Average % doses taken within stand. windows Doses within standardized window (%) * * * * 1 hour 2 hours 3 hours 4 hours * p<0.01 RTMM+ RTMM-
13 Strengths & limitations Focus on unintentionally non-adherent patients Accurate measurement with electronic monitoring Assumption: dispenser opening = medication intake Limited group size Medication adherence intermediate outcome (no clinical outcomes)
14 Conclusion Real Time Medication Monitoring with tailored SMS reminders improves adherence to oral antidiabetics in patients with suboptimal adherence increasing adherence to medication for other chronic diseases
15 Thank you! - Contact information - Marcia Vervloet NIVEL P.O. Box BN Utrecht Tel: m.vervloet@nivel.nl Website:
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