Friday, January 7, 2011

Medication Adherence: A Glance At PubMed

Do you need proof that certain treatment adherence programs can work?

Just plug in “patient adherence” and “cell phones” into PubMed. You'll likely see two Lancet articles on mobile phone use and HIV treatment adherence.  In the Chi and Stringer article, these researchers found that weekly text messages sent to HIV patients in sub-Saharan Africa improved adherence -- 62% versus 50% for the control group – and allowed for better rates of virological suppression (57% vs 48%). Patients who didn’t respond to the text message within 48 hours received a follow-up phone call.

Chi and Stringer raise interesting points in their article. They recognized that the calls were too spread out to actually remind patients to take their antiretrovirals; they speculated that “[p]ossibly the SMS [short message service] intervention worked by improving communication and rapport between health providers and patients.”

Two other points of discussion:  One, the cost. Chi and Stringer write that SMS costs less than $8 per patient.  “This intervention might prove cost effective, particularly when one considers the cost and complexity of second-line therapy. However, this aspect still requires formal analyses.”

The second point the researchers raise: Can cell phones be used to help other patients with other types of chronic diseases?  Chi and Stringer might find the answer to that question in other PubMed articles. In India, at the L.K. Diabetes Centre in Lucknow, diabetes specialists use videos made with mobile phones for diabetes education. They call them “mobi-films.” These mobi-films are used in multiple ways: patient to patient communication, doctor to doctor communication, doctor to patient communication, and patient to doctor communication. As to whether these films have helped improve patient care, the authors write, “Over the years, we have seen a sea change in the knowledge and day-to-day diabetes care skills of people visiting our center and benefiting from our diabetes education films.”

Some physicians are experimenting with cell phones for patients with hypertension; other researchers have seen success with patients with malaria.
And, by the way, Chi and Stringer aren't the only researchers who found that HIV patients are adherent when prompted with cell phone messages; a literature review by other researchers found similar findings.

To us, the travesty of patient non-adherence is that solutions to the problem exist and that people in this country are not adhering to physician recommendations. What is reassuring: That studies are suggesting that innovation can occur anywhere.

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