- Diabetic patients taking part in a telehealth program for chronic disease management experienced better blood glucose control and an 80 percent medication adherence rate when using a smart pillbox that alerted providers to their behavior patterns, reports a study published this month in Telemedicine and e-Health. The patients improved their A1c control by 0.6 percent over baseline while reporting high levels of satisfaction with the nurse-led care coordination program.
As the number of patients at risk for and living with type 2 diabetes continues its precipitous rise, chronic disease management strategies that successfully walk the line between effectiveness and unobtrusiveness are in very high demand. Researchers from Silver Fern Healthcare in Connecticut and Baystate Medical Center in Western Massachusetts developed a three-month telehealth intervention that integrated an electronic pillbox into a suite of remote monitoring tools for patients with poorly controlled diabetes.
In addition to providing participants with a Bluetooth-enabled blood glucose monitor and a wireless blood pressure measurement device, researchers added a smart pill container that automatically uploaded its data to the cloud. With medication lists generated from EHR data, the pillbox helped patients organize their medications while providing patient-facing reminders and provider-centered feedback on medication adherence patterns.
On the provider side, two nurse care coordinators devoted approximately four hours per week to responding to incoming alerts and making a series of scheduled reminder calls to patients who fell behind their medication adherence targets. At the end of the three-month program, provider received a comprehensive patient report that included blood pressure control rates, and blood glucose measurements correlated to a calendar. Patients were also assigned a medication adherence index score on a scale of zero to one hundred.
Twenty-nine out of thirty patients completed the study, the report says, with the majority of patients accessing the pillbox two times per day, averaging two pills per dosage period. Over the three-month study period, the devices generated 78 alerts, only 6.4 percent of which were significant enough to warrant an unscheduled call from a care coordinator.
“Many alerts were considered by the study nurses to be clinically unremarkable and thus did not warrant an outbound call to the patient (typically several days after the event) when normal readings were subsequently seen in the charts based on more recently uploaded remote home monitoring (RHM) data,” the researchers explain.
The patients exceeded recommended use of the blood pressure and blood glucose devices, and generally found the internet-enabled pillbox a helpful tool for their chronic disease care. Average medication adherence was consistently above 80 percent, and even briefly hit 90 percent during one week of the study.
Ninety percent of patients rated the pillbox as an easy-to-use tool, and expressed similar satisfaction with the blood glucose and blood pressure monitoring devices. “Patient satisfaction ratings with the telehealth program were strongly loaded toward ‘strongly agree’ and ‘somewhat agree’ for items assessing happiness with device training and feelings of support from diabetes team,” the researchers said, “and all patients reported they would either ‘strongly agree’ or ‘somewhat agree’ that they would recommend the program to other type 2 diabetes patients based on their experience.”
Patients agreed that the program was both easy to follow and encouraged them to monitor their health more often, improved organizational skills, included clear and uncomplicated interfaces, and did not produce notable inconveniences during their daily home routines.
The eleven providers involved also expressed satisfaction with the program and believed that the intervention provided clinically useful data for chronic disease management and future clinical decision support. All agreed that the summary reports provided at the end of the intervention were easy to understand, and requested that the data be included in the electronic medical record for future access.
While the study only included a small number of patients, the program’s design may be replicable and scalable for a larger and more diverse population. With relatively little training required for care coordinators and patients who choose to participate in similar medication adherence interventions, remote home monitoring devices could be an important tool for the growing number of patients in need of support during their chronic disease management journeys.