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6.3 – Facilitating Medication Adherence and Eliminating Therapeutic Inertia Using Wireless Technology: Proof of Concept Findings with Uncontrolled Hypertensives and Kidney
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6.3 – Facilitating Medication Adherence and Eliminating Therapeutic Inertia Using Wireless Technology: Proof of Concept Findings with Uncontrolled Hypertensives and Kidney

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Wednesday, October 24, 2012 …

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)

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  • 1. Facilitating Medication Adherence & Eliminating Therapeutic Inertia Using Wireless Technology: Proof of ConceptFindings with Uncontrolled Hypertensives & Kidney Transplant Patients John W McGillicuddy, MD, Subtitle Mathew Gregoski, PhD. ,Brenda Brunner Presenters Jackson, MPH, Ana Weiland, BS, Sachin Date Patel, MS, Rebecca Rock, Eveline Treiber, Lydia Davidson & Frank Treiber, PhD. Presented: Wireless Health 2012 ; San Diego, Ca. ,10/24/12
  • 2. 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 & providerguided, SOC validated, mHealth selfmanagement programs areviable solutions
  • 3. BackgroundMedication adherence: extent prescribed dose,Frequency, & timing of regimen followed 50% of patients adhere to medication regimensMed non-adherence leads to: Suboptimal clinical outcomes Reduced work force productivity Increased healthcare costs $100-300 Billion/yr
  • 4. 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.edu http://sctr.musc.edu 843-792-8300 843-792-8300
  • 5. 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.edu 843-792-8300
  • 6. Iterative Design Model Lit Review; theory selection Interview focus group. (Barriers, poss approaches)Efficacy/effectiveness trial Feasibility trial POC trial Surveys(n=99; 80) SMASH devpt http://sctr.musc.edu 843-792-8300
  • 7. Personalized Feedback Development
  • 8. 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.edu 843-792-8300
  • 9. 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 http://sctr.musc.edu 843-792-8300
  • 10. SMASHSMASH Workflow Model Program (BP/Glucose) Control Based upon Self Determination Theory & Patient Centered Iterative Stage Devpt.Automated Automated summary Share data with EMR.Personalized reports and alerts toMessages clinician.
  • 11. Results Hispanic POC  100% recruitment & retention rates  Med adherence of .96 over 3 mths  SMASH -meds changed twice vs none in SOC 24-Hr. ABP 151.28 150 SMASH SOC 140.19 139.56 140 SBP|DBP(mmHg) 130 122.74 120 110 98.13 100 83.4 90 79.6 78.22 80 70 60 SBPpre SBP3mo DBPpre DBP3moResting SBP across 3-months by Intervention 24 Hour SBP and DBP at Pre-Intervention and Group Trial Completion by Intervention Group http://sctr.musc.edu 843-792-8300
  • 12. 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.edu 843-792-8300
  • 13. Results cont. Kidney Transplant Patients Resting SBP Changes 160 SMASH SOC 150.50 150.00SBP (mmHg) 150 148.67 140.50 139.67 Clinical Hypertension 140 133.67 130 Pre 1 2 Months Intervention http://sctr.musc.edu 843-792-8300
  • 14. 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 http://sctr.musc.edu 843-792-8300 http://tachl.musc.edu
  • 15. Thank youWant more information? Visit our website http://tachl.musc.edu http://sctr.musc.edu 843-792-8300 http://tachl.musc.edu