Healthcare Unbound Rapchak2010

Effect of Medication Telemonitoring on Adherence and Behavior

Copyright © 2008-2010 Leap of Faith Technologies, Inc. All Rights Reserved.

Barbara Rapchak, Leap of Faith Technologies, Inc. (815) 356-1767 www.emedonline.com

National Cancer Institute Contract HHSN261200644005C National Institute on Aging Grant R44 AG022271

Copyright © 2010 Leap of Faith Technologies, Inc. All Rights Reserved.

The Problem: Medication Compliance

•  Average rate of compliance is 50%

•  Compliance in clinical trials is 43% to 78%

•  Up to 80% of cancer patients don’t follow prescriptions •  20% hospital admissions related to medications

•  23% nursing home admissions related to medications

•  Self-efficacy important in influencing adherence

Sources: Osterberg, L. and Blaschke, T. Adherence to Medication.” New England Journal of Medicine. August 4, 2005 Partridge, A, et al. “Adherence to Therapy with Oral Antineoplastic Agents.” JNCI Vol 94 (9): 652-661.

“Drugs don’t work in people who don’t take them” —C. E. Koop, MD


NIH Contract R&D Opportunity

•  Integrates and leverages existing and emerging technologies •  Optimizes medication compliance •  Enhances patient self-efficacy •  Automates data collection •  Provides dose-by-dose patient data •  Enables mapping of adherence to outcomes

Could Leap of Faith Technologies develop a medication management system that:


•  Smartphone technology •  Barcode or RFID •  Mobile application and

patient interface •  Web application and

clinical interface •  “Smart service” that can

turn the phone into a medication sensor

A systems innovation in behavior change science and technology

The Solution: Smartphones as Medication Sensors


Technology Demonstration


eMedonline System


CHF Care Transition Use Case Patient Interface


CHF Care Transition Use Case Clinical Interface


The Opportunity: Hour-to-hour / pill-to-pill monitoring

•  For an intervention to be effective it needs to be immediate, personal, and relevant

•  It needs to enable early intervention and a proactive approach

•  Current compliance metrics are driven by prescription fill rates and are retroactive

•  Monitoring refill rates 30, 60, or 90 days out is too late

•  The gap between the behavior and the intervention is too long


•  Illness Representation: Disease state perceived to be non-threatening; belief that compliance will not ameliorate the threat

•  Therapeutic regimen: Complex, long, perceived to be unsafe, inconvenient, costly

•  Patient-Doctor Relationship: Disengaged, lacks communication, not participatory

•  Cognitive Function: Challenged, poor

NON-COMPLIANT

•  Illness Representation: Disease state perceived to be treatable; belief that compliance will ameliorate the threat

•  Therapeutic regimen: Simplified and facilitated by external aids, technologies, and strategies; benefits perceived to outweigh risks

•  Patient-Doctor Relationship: Engaged, facilitated, and participatory

•  Cognitive Function: Enhanced by aids, technologies, and strategies

COMPLIANT

Factors Effecting Medication Compliance


eMedonline engages the patient, creates a touchpoint between the patient and prescription, and establishes a relationship between the patient and the service.

•  The patient gets the right information in the right way at the right time through structured messaging databases and other media.

•  The messages help set patient expectations and illness representation.

•  The patient’s cellphone becomes a technological aid to help them manage their therapy.

•  The patients feel more confident about their ability to manage their medication and disease.

•  The patients feel that it is important to others that they do this.

How do we change behavior?


98% compliance in over 36,000 doses

•  Consistent, clinically significant improvement in self efficacy •  3-month and 6-month randomized control studies •  Funded by NIH and industry sponsors •  Cancer, CHF, and chronic disease patients, age 50 to 88,

taking up to 22 meds daily

Patients who use eMedonline report that they are better able to take their medication as prescribed, get refills on time, and can better manage their medication and disease.


13

“It kept me on task with the medication compliance and I felt a noticeable difference.” (age 55)

“I was already pretty good at taking morning meds but it really helped me get compliant with the evening dose. Also, it may be more timely…same time every day.” (age 43)

“I like the phone call method. Too quick of a reminder for me is easy to forget shortly after. The phone got me more active in the process.” (age 56)

100%

98.2%

90%

85%

Easy to use

Drug compliance rate

Found it useful and used the system daily

Would recommend the system

User Experience Results from Patients (n=80) in a Recent Study

Consistently High Levels of Patient Satisfaction


Usability Study at NCI

•  Validated by independent third part at NCI’s User-Centered Informatics Research Lab

•  Usability and workload evaluated using the System Usability Scale (SUS) and Cooper-Harper Rating

•  SUS score 84.7 indicating optimal usability •  Cooper-Harper Rating 9.4 indicating minimal mental workload •  Patients reported that the technology makes them feel more

confident that they will be able to manage their medications •  Clinicians called the technology “a great boon for the nurse or

clinical trial coordinator”


Patient Feedback

“Simple to use.”

“It makes you feel confident that you’re going to have the very best available opportunity to manage your illness —

whatever it may be.”

“It makes you know that you’re totally and completely up-to-date.”


More information:

Barbara Rapchak Leap of Faith Technologies, Inc. (815) 356-1767 www.emedonline.com www.emedmobile.com

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Healthcare Unbound Rapchak2010