impact of texting & predictive potential of health literacy on medication adherence in type 2...
DESCRIPTION
Presentation at Stanford Medicine 2.0 in September, 2011.TRANSCRIPT
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Impact of Texting & Predictive Potential of
Health Literacy on Medication Adherence in
Type 2 Diabetes
Kevin A. Clauson, PharmD
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Shara Elrod, PharmD
Angela Garcia, PharmD
Elizabeth Sherman, PharmD
Paula Eckardt, MD
Fadi Alkhateeb, BSPharm, MBA, PhD
Support from Mobilizing for Healthsm grant program (Disclosure)
Acknowledgments
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Objectives
• Review fundamentals of diabetes, health literacy, and mobile health (mHealth)
• Explore decision points that informed study design in this research-in-progress interventional SMS study
• Discuss hurdles experienced and future directions
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$174 billion annual cost burden of diabetes
Popul Health Metr 2010;8:29.
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Insulin escorts _________ into the cells
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Insulin escorts _________ into the cells
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Healthy People 2010
“degree to which individuals have the capacity to obtain,
process, and understand basic health information and services
needed to make appropriate health
decisions”
Health Literacy
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eHealth Literacy Lily Model
J Med Internet Res 2006;8(2):e9.
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mHealth is the use of mobile devices and global networks to
deliver health services and information
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mHealth Devices
o Phones
o iPad/TabletPC
o Glowcap
o Raisin
o USB
o Fitbit
o Greengoose
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Who uses mobile phones?
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82% of American
adults owns a cell phone*
*Range: 57% (65+) to 90% (18-29) Pew Cell Phones and American Adults 2010
Owns
Does not own
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87% of blacks and Hispanics own a
cell phone*
P
ew I
nte
rnet
Mo
bil
e A
cces
s 2
010
*Compared to 80% of whites
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Hispanics use their phone to go online and to text more frequently than
any other group*
P
ew I
nte
rnet
Mo
bil
e A
cces
s 2
010
*English-speaking Hispanics
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Improve medication adherence in diverse, underinsured population in USA
with T2DM via text message reminders
Primary Study Objective
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Examine predictive potential of health
literacy for adherence
Secondary Study Objective
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Why choose simple SMS as an
intervention?
GoLiveSMS
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Methods (aka why did we
make the decisions we did in the study)
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Randomized, open-label trial Allocation method where all subjects have equal chance of study group assignment
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Detect a significant difference
(two treatment arms)
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Consumers would most prefer to receive a medication reminder via:
0 20 40 60 80 100
41.1
20.3
19.5
15.2
2.5
1.3 Phone call
Buzzing drug vial
Phone alarm
App
Text message/SMS
Source: Consumer Health Information Corporation, April 2011 (n=395)
Percent
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Smartphone OS Share
38%
27%
21%
9%
2% 3%
Android
iPhone
BlackBerry
Windows
HP webOS
Other
Source: Nielsen Mobile Insights 2011
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People will stop doing almost anything to check their text messages
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Annu Rev Public Health 2011;32:399-416.
Mobile allows targeting of populations historically associated with health disparities
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Study of 130 adult patients with type 2 diabetes
enrolled for 6 month intervention period
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Recruitment from 5 Memorial Primary Care Centers
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How is medication adherence being
measured?
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How is medication adherence being
measured?
Morisky Medication Adherence Scale
Hemoglobin A1C
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Surveys and measurement
REALM-SF Diabetes Knowledge Test
Satisfaction/fatigue
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What hurdles are we trying to overcome?
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Integrating a Tablet For data collection
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Security Privacy Legality
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J
AM
A 2
00
9;3
02
(11):
115
9-6
0.
Honk if you love Jesus if you’re ready Text to meet Him!
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Images
• http://www.mhs.net/
• http://www.ucwv.edu/
• http://www.mckesson.com/en_us/McKesson.com/
• http://www.quickpwn.com/2010/06/iphone-4.html
• http://cdn.pocketnow.com/html/portal/news/0000015324/incredible-s-screen.jpg
• http://www.atakos.com/wp-content/uploads/2011/04/Blackberry-8800.jpg
• http://www.mobirolla.com/wp-content/uploads/Windows-Phone-7.png
• http://mobihealthnews.com/7074/vitality-taps-telit-for-glowcap-connectivity/
• http://online.wsj.com/article/SB124934548487503195.html
• http://www.vidagranola.com/wp-content/uploads/2010/03/fitbit.gif
• http://news.cnet.com/i/tim/2011/02/23/IMG_2143_610x458.JPG
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Images
• http://cowbgonaca.blogspot.com/2011/06/wallpaper-for-android-mobile.html
• http://www.mac-wallpapers.com/Apple-Wallpapers/white-apple-logo-wallpaper/
• http://www.laptopsteria.com/wp-content/uploads/2011/06/blackberry-logo.jpg
• http://www.iphonewallpaperblog.com/wp-content/uploads/2010/12/Windows-7black-iphone4Walpaper.jpg
• http://www.mhs.net/locations/PrimaryCareCenters.cfm
• http://h10010.www1.hp.com/wwpc/pscmisc/vac/us/product_pdfs/Slate_500_Tablet_Datasheet.pdf
Images without citations are licensed stock photography
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Hot-Button Issues
• Will privacy and legal challenges stifle innovation and the delivery of mobile-mediated care to at-risk patient populations?
• Could better decisions have been made about study design given the available information at the time?
• Will our research result in findings consistent with our research hypotheses and mHealth model assumptions?