AudiencScapes

A new study proving the effectiveness of mobile phone technologies in relaying medication adherence information from hypertension patients to healthcare professionals in the U.S. has applications globally. If proven successful, scalable and geographically feasible in diverse locations, such applications can potentially transform health care systems and help prevent fatalities through simple use of one’s mobile phones.

Gayatri Murthy

It is becoming more apparent every day that the advancement of mobile phone technology can be harnessed to aid health care systems globally. A particular focus in this mobile health (mHealth) research and development has been using mobile phone technology to increase information relay from patients to healthcare professionals using cell phones.

One such health care challenge that can benefit from mobile phone applications is Medication Adherence- that is, ensuring that patients take their medication regularly as prescribed. A recent report by the World Health Organization (WHO) revealed that 50 percent of patients with chronic disease do not take their medications as prescribed. The Center for Connected Health states,

“Poor medication adherence leads to increasingly poor health outcomes for patients and has a significant negative economic impact on healthcare resources. Readily-available communications technology can provide real-time information and feedback to patients, to support improved medication adherence.”

At a recent talk titled-“Medication Adherence and mHealth”, held at George Washington University in Washington , D.C., National Institute of Health (NIH) Health Scientist Wendy J. Nilsen defined medication adherence as high up on the list of challenges faced by healthcare professionals. Research she has conducted at the NIH’s Adherence Research Network, she said, has constantly reaffirmed the fact that proper adherence elongates life.

The real challenge is to adequately measure lack of adherence. Finding patients who will actually inform their healthcare provider that they are non-adherent goes against proven patient behavior. Those willing to volunteer participation in an adherent study are probably already focused on remedying their non-adherence. The challenge, then, is to target chronic non-adherents, with limited healthcare literacy, limited income and education, and intervene in their healthcare to prevent real fatalities.  In fact, Dr. Richard Katz, director of cardiology at the GWU Medical Center, also present at this event, stated that 33 to 69 percent of all hospitalizations in the U.S. can be blamed on improper adherence, costing an unnecessary $100 billion a year.

This is where mobile technology can help. The George Washington University’s Medical Center  (in collaboration with One Economy, Cricket Communications, VOCEL ), and Qualcomm Incorporated, through its Wireless Reach initiative, presented the results of their Pill Phone Hypertension Medication Adherence Study at this event.

In this study, 50 hypertension patients in Washington, D.C. with diagnosed hypertension and an average prescription of 8 medicines were monitored for a period of seven months. Demographically, the patients had an overwhelmingly low adherence rate - on average this group had only an 8th grade level of health literacy, and only 17% of them had a college degree.

Each patient received a 3G wireless handset pre-loaded with the Pill Phone application. The Pill Phone provides patients with visual and audible medication dosage reminders, tracking and storage of dosage records, image displays of prescription pills and access to real-time information about potential drug side effects and interactions. Patients were trained to use the Pill Phone application and educated about hypertension and the importance of medication adherence. Health care providers were able to use the application to remotely monitor patient adherence through a secure web site.

There was a pre-study period, followed by period when they were given “Pill Phones” that reminded them about their medications and reported back to the clinic. This was followed by monitoring patients after the Pill phone was taken away from them. In the words of the researchers, “The Pill Phone study was intended to show how wireless technology can engage patients, improve health outcomes and reduce health costs.”

Results found that patients had a high level of acceptance and sustained use of the Pill Phone application. The average rating on the Morisky Scale of Medication Adherence (a 4-item scaled questionnaire to assess adherence with antihypertensive treatment) did improve during the period of the study. Patients also had improved blood pressure rates; although researchers did admit that measuring actual physical adherence was still impossible. This is because; a patient replying to a reminder with “medication taken” is still not the same as him/her taking the medication. The information relayed to the healthcare professional through mobile technology is “patient responded to mobile phone reminder” as opposed to “patient took medication”.

This is a limitation even the most sophisticated mHealth technology will face, but the success of many other adherence studies points to benefits for health care systems.

 One other innovation referred to by Dr. Katz at the event was the London-based SIMpill. It is a small pill bottle that contains a SIM card and when opened, the SIM card delivers a message to a central server. The central server receives the incoming SMS and stores the data, but if no SMS is received at the designated time, the server contacts the patient via phone alerting them to take their medication. This was effectively used among patients in South Africa suffering from Tuberculosis- another chronic disease that requires taking strong antibiotics for 6 months. This study conducted among 155 TB patients in Cape Town showed a drug adherence rate of between 86 and 92 percent after patients had used the SIMpill for 10 months.

Another such study conducted by the US President’s Emergency Plan for AIDS Relief (PEPFAR) was based on more direct intervention, where a nurse practitioner would send out weekly SMS messages to HIV patients participating in the study and patients were required to respond within 48 hours with a response. If they didn’t, the nurse could call them to enquire. Results showed higher adherence (62%) among the sample group than those who did not receive any SMS reminders (50%).

The main advantage of such applications is simple, yet revolutionary- - when these technologies are proven scalable and accessible, health care providers will be able to observe real time records of all their patients, which would be constantly updated as patients’ cell phones relayed information back to the system. This means any healthcare provider can actually intervene in the case of non-adherents at the right time, and thereby, minimize hospitalizations and fatalities.

Another crucial factor for such initiatives to work globally and among poorer and less literate populations is the availability of cheap and simple mobile technology. The Pill Phone discussed at the event I attended, was not a smart phone, and Vocel, together with Cricket Communications, were able to provide a user friendly cheap phone for the purposes of this study. Continued innovation of such technology will be imperative for mHealth success.

Gayatri Murthy is a Research Assistant for the AudienceScapes
Project and helps in analyzing the AudienceScapes data, writing the
Country Profiles and overall maintenance of the website. You can reach
her at murthyg@intermedia.org