|
Information can be sent direct to patients’ mobile
telephone handsets
|
The mobile telephone has evolved from humble origins as the “must
have” yuppie accessory of 15 years ago into an all-singing, all-dancing
multimedia fashion item, and few would dispute that it is now an indispensable
part of modern life. Now it looks set to revolutionise pharmacists’ involvement
in the management of chronic conditions like diabetes, asthma and hypertension.
The first generation of mobiles were more accurately described as “transportables”.
The size and weight of house bricks, they were just about capable of
facilitating a two-way conversation in the places where (patchy) network
coverage allowed. From these small acorns, mighty hand-held computers
have grown. Today’s mobile can take and send still photographs
and video, download ringtones, browse the internet, send and store a
mountain of text messages, and play MP3 music files. And you can still
talk on it, too.
Field testing
Therefore, because of their ubiquity and data transfer capability,
mobiles are starting to make their mark in medicine. Vodafone has been
field-testing
neurosurgical telemedicine applications using third generation (3G)
technology in Germany.
Scientists in Denmark1 have successfully used text messaging to collect
diary data from asthma patients in a pilot study to determine whether
increased remote support improves clinical outcomes. Previous studies
using home PCs to send the same diary information proved disappointing,
with users rejecting the application after a short while.
Researchers from the Norwegian Centre for Telemedicine in Tromso2 studied
parent-child interaction using a mobile and wireless system for blood
glucose monitoring, and concluded that, whether or not the health outcome
is improved as a result, the peace of mind provided by such a system
may make it a commercial proposition.
In Finland, Medixine has been promoting home care by integrating diagnostics
and patient diaries before sending results via a PC based web-link to
health professionals. The company is now offering the same functionality
using hand-held mobile PCs.
Researchers in the UK have, however stolen a march. When scientists from
Oxford University3 set out to determine whether a system based on automated
transfer of data, real time analysis and immediate feedback to the patient
could improve glycaemic control for young adults with type 1 diabetes,
they adopted the mobile approach.
The substantive difference between their work and others cited in the
literature is that, with the help of funding from the charitable Vodafone
Foundation, professors Andrew Neil and Lionel Tarassenko were able to
conduct randomised clinical trials.
For the first time, the use of mobile telephone technology was proved
to have a significantly beneficial effect and resulted in demonstrably
improved clinical outcomes.
The system involved in the trials, which has subsequently been made commercially
available under the “t+ diabetes” brand, uses a glucose meter
linked by Bluetooth to a GPRS-enabled mobile telephone. (GPRS allows
a handset to communicate with a remote server without the user having
to dial in manually.)
After the patient has taken a reading in accordance with the advice he
or she has been given by a GP or practice nurse, they spend around 10
seconds adding essential diary information about diet, exercise and general
health via the telephone’s keypad. The system is intuitive and
easy to use.
The information, together with the reading, is sent by the handset to
a central computer which responds within seconds, providing patients
with personalised feedback in easy-to-read graphical format delivered
to their mobile’s display.
The number crunching done by the remote computer uses sophisticated algorithms
to help negate the effects of occasional rogue readings and deliver a
consistently meaningful result to the patient’s mobile. At a glance
Using the system, patients can see at a glance how successful their
glycaemic control has been since the previous reading, or over the past
week,
month or year. They can also see immediately the influence that specific
lifestyle elements and events have had on their blood glucose levels
as a result of the data they sent with the glucose reading in the
patient diary. Patients who used their mobile to help control blood sugar
levels
during the nine- month randomised clinical trial reported significantly
lower blood glucose levels than the control group: · There was a reduction in HbA1c in the intervention group after nine
months from 9.2 per cent (SD=1.1) to 8.6 per cent (SD=1.4)
· The proportion of patients achieving an
HbA1c <= 8.0 per cent at
nine months increased in the intervention group from 10.6 per cent to
46.8 per cent
· The authors concluded that real-time feedback
using GPRS mobile telephone technology and targeted nurse support leads
to sustained levels of monitoring,
improvements in blood glucose levels and attainment of HbA1c targets
Systems like t+ diabetes bring self-management within the reach of up
to 90 per cent of the population because feedback is delivered direct
to patients’ mobiles, wherever they
are when they take a reading. Patients are empowered to make the right
decisions about the management of their diabetes because they are provided
with the right information when they need it.
With a patient’s consent, pharmacists can keep an eye on blood
glucose readings by logging on to a secure web site |
Systems such as t+ diabetes
will, in time, mean that GPs, practice nurses and specialist diabetes
nurses are able to keep track of their
patients’ progress
without having to see them in surgery time. Alerts can be generated if
blood glucose levels fall outside defined parameters while 24-hour supervision
is possible by accessing a secure website. At the same time, t+ diabetes
offers new opportunities for the pharmacist.
The version of t+ diabetes involved in the trial included medicines management
software which alerted the patient when prescription items were running
low. The commercially released product has taken this functionality and
added to it. Patients are now able to order repeat prescriptions remotely
from within the t+ diabetes application. This means that pharmacists
are alerted to any issues surrounding potential medicines misuse which
can be addressed when the prescription is filled. Self-management
This led e-San Ltd, the company responsible for the development of
t+ diabetes, to consider how pharmacists could become more involved in
patients’ self-management of chronic disease using systems like
t+ diabetes.
The company, which is in the process of developing remote self-management
systems for hypertension and asthma, realised that the mobile approach
offers pharmacists an opportunity to make a greater impact as part of
the extended health care team.
Pharmacy services seem poised to make an increasingly significant contribution
to the community health care of people with diabetes and providing services
to this group of patients is likely to become an important source of
revenue.
Phil Jones, e-San’s commercial director, says: “Why should
the pharmacist only be involved in screening and medicines use reviews?
Products like t+ diabetes will encourage the greater involvement of pharmacists
in the management of chronic illness. By the pharmacist keeping a close
eye on the way prescription medicines are used, misuse levels and wastage
should go down, while greater compliance means medical outcomes will
improve. At the same time, the patient will be relieved to know that
someone is keeping a regular check on their progress.”
With chronic diseases like asthma, diabetes, hypertension and coronary
heart disease affecting up to one in five of the population, Mr Jones
predicts huge opportunities for the community pharmacist.
“We realised that mobile telephone technology is commonplace and
now found across the age range — t+ diabetes was successfully tested
in a group that included 80-year-olds. If a system is easy to use, and
combines
the disease self-management element with the convenience of reminders
and the automatic ordering of repeat medicines at the touch of a button,
it will become very popular,” says Mr Jones.
He adds that t+ diabetes not only gives customers more reasons to remain
loyal to the pharmacist who initially supplied the self-management system,
boosting revenue from repeat prescriptions, but it saves a significant
amount of time; savings of up to two hours per week per pharmacy have
been reported.
e-San is working with a major chain on a nationwide roll out, but t+
diabetes is already available via a network of independent pharmacies.
Mahesh Amin, of Calder Pharmacy in Notting Hill, London, is one of the
first to stock t+ diabetes.
“
It’s a product that’s come around at just the right time
for us,” says Mr Amin. “We were already planning to do more
by way of medicines use review, but t+ diabetes is going to enable us
to get even more involved in patient treatment. We are ideally placed
to analyse medicines use and counsel the patient about any issues we
spot. If we can develop a closer relationship with the patient, we’ll
be better placed to draw any problems to the attention of their GP.” Greater involvement
“We’re looking forward to the greater involvement in patient
management as well as the increased patient loyalty that we think will
follow. We
have a good relationship with our local GPs. We’re already talking
to them about supplementary prescribing and
the new contract. They are very much in favour of their community pharmacist
having greater involvement in the treatment of patients with chronic
conditions,” adds Mr Amin.
“In general, GPs’ attitudes have changed. Whereas they used
to be set against pharmacists becoming more involved in patient care, for
the
most part they now welcome it. They trust us to pick up their mistakes.
Why not trust us to keep a closer eye on the well being of their patients
with chronic conditions,” Mr Amin asks.
Mr Amins says he sells a fair number of blood glucose meters. He acknowledges
that t+ diabetes and other mobile telephone based self-management systems
are not going to be suitable for all patients, but that they will be
useful to many. He says it is common for people to come back after a
few days of readings and ask, “what now, what do we do with this
data?”. He believes t+ diabetes will help them make sense of their
blood glucose readings and see the impact that changes in their diet
and exercise regimen have — and that should make a real difference.
As well as facilitating a closer involvement in patient treatment, t+
diabetes will promote greater patient loyalty. “I can see this
kind of technology being applied to other disease management regimens,
including heart disease and asthma,” says Mr Amin. “In years
to come, supervising this kind of mobile telephone-based self-management
will be an accepted part of what we as pharmacists do.”
STATEMENT Stuart McWilliam’s primary occupation is that of a freelance
journalist specialising in mobile telephones. He has worked with e-San
on the design and implementation of t+ diabetes and other mobile telephone
based-systems for chronic disease management.
References
1. Anhoj J, Moldrup C. Feasibility of collecting diary data
from asthma patients through mobile phones and SMS (short message service):
response
rate analysis and focus group evaluation from a pilot study. Journal
of Medical Internet Research 2004:6:e42.
2. Gammon D. Parent-child interaction using a mobile and wireless system
for blood glucose monitoring. Journal of Medical Internet Research 2005;7:e57.
3. Farmer AJ, Tarassenko L, Neil A. A randomised controlled trial of
the effect or real-time telemedicine support on glycaemic control in
young adults with type 1 diabetes. Diabetes Care 2005;28:2697–702. |
The
Pharmaceutical Journal