[ARCHIVED] Adherence & Retention
transmission of medication monitor record with simple cell phones
I am posting the following on behalf of Dr. Tom Moulding from UCLA. Any feedback would be much appreciated!
Obtaining the Adherence Record from Medication Monitors Using Two Different Tones from the Monitors with Unmodified Mobile Phones
Tom Moulding M.D.
A recent article (1) describes how medication monitors could be used to determine which TB patients are sufficiently adherent to take self-administered treatment and which patients require more intensive supervision. Use of mobile phones to transmit the monitor record to the clinic at weekly intervals should improve the effectiveness of medication monitors. The least expensive data transmission system that does not require modifying existing phones includes: 1) A microcontroller in the medication monitor which stores the adherence record of the patient. 2) A beeper on the monitor that produces two different tones. 3) A cradle on the monitor, which positions the mouthpiece of the patient’s mobile phone over the beeper and 4) switches to activate a data transmission session.
To transmit the data either the patient would call the clinic or the clinic would call the patient at a pre-designated time. The patient would position the microphone on his or her mobile phone in the cradle on the monitor. The beeper would create a one-second tone for each midnight since the last transmission session represented by a (--) in the illustration below and a short beep for each opening of the cover of a cover opening monitor or removal of a dose from a dose removal monitor represented by a ( . ).
_ . _ . _ . _ . _ . _ . _ . _ The patient opened the cover each day.
_ . _ _ _ . _ . _ _ . _ The patient didn’t open the cover on day 2,3,&6.
_ _ _ _ _ _ _ _ The patient didn’t open the cover for a week.
After hearing the adherence record, the caregiver would talk to the patient giving praise for a good adherence record or expressing concern about poor adherence while stressing the importance of uninterrupted treatment and letting the patient express his or her concerns. This process would take staff time and transmission time that must be paid for. However, the maintenance of human contact with the patient, even though it is only voice contact, should prove to be helpful in maintaining rapport and improving adherence. Furthermore, phone discussions regarding minor deficiencies in adherence would take far less time than a home visit to correct the problem.
In addition to listening to the adherence record, the clinic staff could use a digital voice recorder (2) to store the adherence record for use in preparing a permanent record from the beginning of therapy to decide on how to manage patients with good, modestly poor, or bad adherence records. Such management could include 1) free cell phone minutes for good adherence records, 2) counseling over the phone for patients with minor defects in adherence, 3) periodic home visits to reinstruct the less adherent patient and family, 4) ordering strict DOT given by some reliable and persuasive person outside the family for the grossly non-adherent patient, and 5) extending the duration of therapy based on the adherence record.
The section of the website,www.medicationmonitors.net VII F Communicating by Mobile Phones provides a detailed description regarding this data transmission system.
References:
1) Moulding T. A neglected research approach to prevent acquired drug resistance when treating new tuberculosis patients, INT J TUBERC LUNG DIS 15(7):855–86
2) Website for digital voice recorder that costs $40.00 but is used only in the clinic. http://www.musiciansfriend.com/pro-audio/rca-vr5320r-1gb-digital-voice-record... software/h72408000000000?src=3WFRWXX&ZYXSEM=0&CAWELAID=800589643
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