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Cell Mobile Driven Patient Adherence Schemes

Cell Mobile Driven Patient Adherence Schemes

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Published by Bart Collet
What success have you seen in Cell/mobile driven patient adherence schemes?
Comprehensive Behavioral Health Management to Introduce Life:WIRE’s Innovative Mobile Health Management Solution to Support Community Care Coordination Study 
What success have you seen in Cell/mobile driven patient adherence schemes?
Comprehensive Behavioral Health Management to Introduce Life:WIRE’s Innovative Mobile Health Management Solution to Support Community Care Coordination Study 

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Categories:Types, Research
Published by: Bart Collet on Mar 18, 2009
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06/22/2010

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Klynn AlibocusWhat success have you seen in Cell/mobile driven patient adherence schemes?
Comprehensive Behavioral Health Management to Introduce Life:WIRE’s Innovative MobileHealth Management Solution to Support Community Care Coordination Studyhttp://insurancenewsnet.com/article.asp?a=featured_pr&id=103867
Steven Dean
I'm one step removed from the patient/end customer in this space, but as the Director of Medical Marketing at TI, I believe any and all success will be born out of an automated systemwheras the patient is removed from the process. Any body worn device that behavesindependently, monitoring and communicating via GSM/GPRS, or other means to a 'hub' ordirectly would be a hit.
Sean Wheeler
I'd like to see this kind of adherence scheme pushed further to use not only datacommunications, but exploit the full potential for integrated ubiquitous communications. Ibelieve to be a successful offering, monitoring (automated or not) is not enough. Ultimately,the benefits of adherence must be communicated to the patient, otherwise even the bestmonitoring technology is wasted. I think real person-to-person interaction is more valuable inachieving this goal than delivering predefined adherence tips, for example.In my opinion, given the cost of patient monitoring, the remote partner in adherence schemesmay not even be a caregiver (especially in a cost-sensitive deployment), but a peer (such as apartner in a patient social network site).
Susan Dorfman
 I would hardly call patient adherence programs "schemes." If done properly, the use of mobiledevices can be quite beneficial and convenient for some patients. Cegedim Dendrite has goodand comprehensive adherence methodology, which includes the use of mobile devices as acomponent of proactive care.
Lyle Bullock
As the Director of Confidant Hawaii, we are currently conducting a study with a local hospitaland university on the use of cell phone technology to improve compliance and improve patientcommunication concerning Gestational Diabetes. There are drawbacks due to the carriers andnetworks involved, but the results have shown the patient is more likely to take glucosereadings at the correct times as directed and since it is automated, there is little error in thereadings obtained. In addition, the system provides automatic feedback based on the readingsand the clinical staff has an easy way to message the patient with information and instructions.
Mikko K. Leino
 Using cell phones, text or mobile applications, for reporting readings is one thing. Formedication compliance, Helsinki, Finland-based Addoz has a product with embedded GSMconnectivity. Daily medication is prepared to compartments by caregiver, and the automaticdispenser device reminds the patient to take them on time. If the medication is not takendespite the reminders within one hour's grace time, the device sends out an alert by SMS.There's a case study where reminders combined with back-up calls from the care centre topatients has provided 97% medication compliance rate. With GSM connectivity, there's noneed for other infrastructure like care phones. However, medication dispenser may also have aproprietary social alarm transmitter, in which case alerts are first received by a carephone andthen forwarded to the care centre.
Chris Johnson
Ouch, Steven. Compliancy is a complicated psychological issue for most clients. While somemay simply forget, others are concerned about side-effects, trust their own feelings and
 
embark on self-dosing, while others believe more in herbal remedies than in pharmaceuticals,or simply don't want big brother looking over their shoulder. In my opinion, the main enablerfor compliancy discussions is an accurate (electronic) registration of probable dosage events toenable self-monitoring, involvement of carers and family, and fact-based discussion withprofessionals. I do not see any effective route forward in which the free-will of the patient isremoved from the process.The mobile phone is a useful tool. Patients can easily check their own compliancy on a personaldevice. Providers benefit from an existing infrastructure with the widest coverage. Feedbackand coaching is done on the same device. "Hubs" can also be developed using mobiletechnology for simple use by the elderly - see our sitewww.cypak.comfor one example.
Marc Stober
Let's not overthink this, and start with what's simple. It could be pretty cheap to build aniPhone or Blackberry app that lets patients track their measurements or dosages and optionallyshare that information with a provider between visits. If getting 100% compliance fromMedicare patients is too complex then pilot it with a population like gestational diabetes or IVFpatients who are looking for more ownership of their health and are already seeking out waysto do this with technology.
Susan Dorfman
If you want to start with the basics, take a look at Chris Johnson's comments on barriers topatient adherence in relation medical regiments. What you will find is that mobile technologycan be a great source to address many of such barriers through electronic interventions - all of which should be complimented by other personal and non-personal touchpoints for ultimatesuccess.
David Youngs
 We have not used this approach before. It will be interesting to see its efficacy in improvingadherence to regimens addressing chronic problems such as diabetes and weight control,exercise. Also, across age groups. Will older people, aging boomers, etc. find it effective? Tome it seems that a combination with an automated CRM system might work.
Khinlei Myint-U
 We recently completed a trial to assess the effectiveness of simple text message reminders onadherence to topical medication. We found that adherence rates for the reminder group werealmost double that of the control group. There's more informationhere:http://www.connected-health.org/programs/medication-adherence/center-for-connected-health-models-of-care/sunscreen-adherence.aspx
Jennifer Priester
To follow-up on Khinlei's comment, Joseph Kvedar, MD is presenting data about this study thisweek at the the 67th Annual Meeting of the American Academy of Dermatology. More info ishere:http://news.prnewswire.com/ViewContent.aspx?ACCT=109&STORY=/www/story/03-05-2009/0004983952&EDATE= 
David Doherty
I share Steven's opinion.@Chris Johnson: Steven isn't saying that the patient' free-will needs to be removed from theprocess but that the process itself needs to be automated.I'll give an example of this. Using technology to measure body temperature every time thephone is placed next to the ear can be very useful in long term monitoring and requiresnothing more than the patient using a specially designed phone in exactly the same way they
 
would normally use a cellphone ie. NO BEHAVIOUR CHANGE.I have had access to enough data on mobile applications to know that they have a shelf lifethat isn't compatible with long term medication/monitoring.I'm afraid i think it is only when completely automated (as in this example) OR some type of community game is being played that these technologies will be a hit with patients.
David Youngs
This approach could be used for elder/disabled market, particularly in the PACE setting.Program of All Inclusive Care for the elderly are hospital based, so maybe an approach like theone used in Lyle Bullock in Hawaii could be expanded to that population.
Chris Johnson
David Dohertry, I do agree that solutions have to be very easy - even automatic - for clients.We have done a lot of work on using NFC cell phones to read data from a standard medicationpack. The pack contains an active RFID tag to record dosage events and other client feedback.They can be read simply by putting the phone and the pack in close proximity. The battery lifefor the tag is not a limiting factor.NFC phones are becoming more common after the success in Japan, where over 100 millionhave been sold for applications like payments and transport. They are also cool for the youthmarket because it is much easier to swap photos and ring tones than setting up sessions withBluetooth.
David Doherty
@Chris Johnson: I'm a big fan of mobile device (and SIM card based) NFC but it seems there isa lot of confusion as shown by your own comments...* The tag in the meds doesn't need to be active as this adds cost, the phone is carried all thetime anyway, and it is a less capable and not as well designed as a mobile to store healthcaredata. A good place to find out more about these issues would be the Nokia/Visa/Telefonicaresearch into NFC that was conducted last year at Imperial College London.* How does client (patient?) give feedback to an active tag?* In Japan/Korea etc NFC technology is NOT being used to transfer multimedia content asBluetooth is still a lot better for this purpose. They are being used to HANDSHAKE the mobilesso that a bluetooth push and download is initiated. The data transfer is still taking place usinga Bluetooth session and all the NFC is being used to do is avoid the need for the send/acceptto be initiated.Hope this helps with a bit of clarity?A good source for more general information about NFC can be found athttp://www.technovelgy.com/ct/Technology-Article.asp?ArtNum=50 
Chris Johnson
The active tag is embedded in the medication pack (carded blister, bottle, etc) to recorddosage events. So for example, when a blister is popped a printed trace is broken and theevent time stamped and recorded in the pack. The same when a bottle is opened or an inhalerused.The advantage of this approach is that it is "automatic" for the client. And the data is storedand can be read by any NFC reader - by client themselves, visiting nurse, carer, pharmacist,etc. Some of these readers may be embedded in Blackberry, PDA, Cell phone - others not.

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