Effect of Home Blood Glucose Telemonitoring with Self-Care Support on Glycemic Control in Pregnancy

AG Lagain,¹DS Feig,²R Fung,³I. Bahinskaya,⁴D. Ng,⁵P. Picton,⁶JA Cafazzo^6
1Prosserman Centre for Health Research, Samuel Lunenfeld Research Institute of the Mount Sinai Hospital ²Departments of Medicine of the Mount Sinai Hospital and University of Toronto³Department of Medicine, Toronto East General Hospital 4Institute of Health Policy, Management, and Evaluation, University of Toronto ⁵Institute of Biomaterials and Biomedical Engineering, University of Toronto ⁶Centre for Global eHealth Innovation, University Health Network, Toronto, Ontario, Canada

Journal MTM 1:4S:32, 2012
DOI:10.7309/jmtm.54

Abstract

The Office of Cyber Infrastructure and Computational Biology (OCICB) of the National Institute of Allergy and Infectious Diseases (NIAID) at the NIH has been developing a solution that complies with current guidance frameworks and regulatory requirements while leveraging the potentials offered by mHealth technologies for data collection. OCICB has designed an mHealth solution that maps to the paper processes developed over the past century for clinical research. We designed the system for use in regions of low to middle-income countries where the patients often have no other clinical record. For our pilot, we selected a natural history study that does not have the same regulatory requirements as an Investigational New Drug (IND) study. We retained our existing paper-based clinical data capture management system in order to compare quality control reports between paper-based and mobile electronic capture methods. The solution complies with regulatory frameworks and requirements such as Good Clinical Practices and 21 CFR Part 11, which requires full audit trails of the data collection process at the source and the validation stages. It also provides the capacity for workflows that support the data validation process within the field research framework. We expect to show that the accuracy of data collection improves using mobile source data collection. This will reduce the time and cost of validating the collected data before final analysis for clinical research while maintaining the regulatory framework that protects patient interests. The solution will further provide clinical monitors with the ability to remotely access the source data and thus reduce the cost of travel for monitoring as well as reducing the impact on patients due to mistakes made while entering the data.

High Tuberculosis Treatment Adherence Obtained Using Mobile Phones for Video Directly Observed Therapy: Results of a Binational Pilot Study

Richard Garfein,¹Kelly Collins,¹Fatima Munoz¹Kathleen Moser,²Paris Cerecer-Callu,³  Mark Sullivan,⁴ Ganz Chokalingam,⁴ Phillip Rios,⁴ Maria Luisa Zuniga,¹  Jose Luis Burgos,¹  Timothy Rodwell,¹  Maria Gudelia Rangel,⁵ Kevin Patrick^6
1UCSD, School of Medicine, Division of Global Public Health, San Diego CA²San Diego County Health and Human Services Agency, ³ISESALUD, Secretaría de Salud del Estado de Baja California, ⁴UCSD, California Institute of Telecommunications and Information Technology, San Diego, CA, ⁵US/Mexico Border Health Commission, Tijuana, BC, Mexico, ⁶UCSD, Department of Family and Preventive Medicine, San Diego, CA

Journal MTM 1:4S:30, 2012
DOI:10.7309/jmtm.52

Abstract

Over 8.8 million people become ill and1.4 million people die annually from tuberculosis (TB). TB is treatable with antibiotics; however,poor adherence to daily medication regimens lasting >6 months promotes ongoing disease transmission, higher mortality, and development of drug resistance. “Directly observed therapy” (DOT) is recommended to minimize these problems. DOT healthcare providers watch patients take each dose of medication, hence DOT is costly, time consuming, invasive for patients, and is limited to patients who live near a health center. Informed by focus groups and expert opinions among patients and providers, we developed and pilot- tested a method called Video DOT (VDOT) whereby patients use mobile phones to record and securely transfer time-stamped videos of themselves taking their medications, which are then watched remotely by their provider. The study was conducted in San Diego, CA (n=43) and Tijuana, Mexico(n=9). To date, 38 patients have completed TB treatment using VDOT. Patient ages ranged from 18 to 86 years, 54% were male, and 77% were non-white. Overall, 90% and 97% of the expected videos were received on-schedule from patients in San Diego and Tijuana respectively. Post-treatment interview responses were similar across cities. Patients and providers easily adopted the technology. Patients required only 3 training sessions on average before being able to perform VDOT independently. Overall, 89% of patients reported never or rarely having problems recording videos, 92% preferred VDOT over in-person DOT, and 81% thought VDOT was more confidential. All patients said they would recommend VDOT to other TB patients. Three participants were more compliant after switching to in-person DOT, suggesting the need for both DOT options. VDOT provides a promising mobile solution to the high cost and burden of in-person DOT for monitoring TB and other conditions that require strict treatment adherence.

Evaluation of a SMS Medication Reminder System to Improve Medication Adherence in African Americans with Uncontrolled Hypertension

Lorraine Buis,¹ Loren Schwiebert,² Nancy Artinian,¹ Hossein Yarandi,¹  Lindsey Hirzel,¹ Rachelle Dawood,³ Lynn Marie Mango,³ Phillip Levy^3
1Wayne State University, College of Nursing, ²Wayne State University, Department of Computer Science, ³Wayne State University, School of Medicine, Department of Emergency Medicine

Journal MTM 1:4S:29, 2012
DOI:10.7309/jmtm.51

Abstract

African Americans are disproportionately more susceptible to Hypertension (HTN) than non-Hispanic Whites, which is a leading cause of cardiovascular disease. Poor adherence to prescribed medication regimens is a major contributor to HTN, as only about half of patients are adherent. Moreover, while the majority of HTN treatment is delivered in primary care settings, a sizable proportion of care is provided in the emergency department (ED), particularly within low income communities. Short Message Service (SMS) text messaging may offer a simple, non-labor intensive strategy for improving medication adherence among African Americans in both primary care and ED settings, as text message use within this population is widely integrated into everyday life, even among the lowest income levels. The goal of this evaluation is to determine intervention efficacy, as well as to establish the feasibility and acceptability of using an automated SMS intervention to improve medication adherence in African Americans with uncontrolled HTN in these settings.

We recently launched two randomized controlled trials (RCTs) of uncontrolled hypertensive African Americans in Detroit, MI; one with participants from primary care clinics, and one with participants from an ED. The primary outcome measure is change in medication adherence from baseline to one-month follow-up. Secondary outcome measures include changes in blood pressure and medication self-efficacy, participant satisfaction and acceptability, and feasibility of use in our target population. We have currently enrolled 9 participants in the primary care RCT and 7 participants in the ED RCT (target n=70 in each RCT) and preliminary evaluation results are forthcoming. Although the evaluation is ongoing, several lessons regarding the conduct of mHealth research within limited resource settings have been learned including overcoming recruitment and enrollment barriers, challenges associated with utilizing SMS-based interventions with low-income targeted mobile phone carriers, and strategies for retaining participants from baseline to one-month follow-up.

A Cross-Language Mobile Resource for Accessing MEDLINE/PubMed Based on an Open- Source, Crowdsourced Controlled Medical Vocabulary for the Philippines

Raymond Francis R. Samiento,¹Fang Liu,¹Paul Fontelo^1
1National Library of Medicine, National Institutes of Health, Bethesda, Maryland, USA

Journal MTM 1:4S:28, 2012
DOI:10.7309/jmtm.50

Abstract

Using a standardized set of medical terminologies can help organize EMR content and facilitate patient care, follow-up and documentation in countries with many official languages. A controlled medical vocabulary of clinical terms from patient-provider encounters was developed from submissions of members of the medical community in the Philippines. Crowdsourcing may be useful for building standardized medical terminologies. It also increases awareness on MeSH, SNOMED CT and the UMLS.

Introduction: There is a need for a standardized set of medical terminologies to avoid loss of translational integrity of the chief complaint. A controlled medical vocabulary will be useful for a country like the Philippines which has eight major languages. Using the patient’s exact words of the chief complaint is crucial since it often leads to a diagnosis. This study describes the development of a cross-language tool in the Philippines using mobile devices.

Methods: We announced a call through social media for submission of translations of medical terms. Healthcare personnel could either manually enter a medical term and its translation to one of the eight languages, or provide a translation of a MeSH term after selecting one from the following categories: Disease, Signs and Symptoms, Pharmaceutical Preparations, Health Occupations, Diagnosis, Therapeutics, and Other. Experts from the University of the Philippines Center for Filipino Languages (SentrongWikang Filipino) will validate the translations. If a MeSH term has multiple submitted translations, the experts choose the best one from the entries.

Results and Discussion: A standardized controlled medical vocabulary for the Philippines was developed using a mobile- friendly interface. To date, the database contains 2,447 translations. Filipino (29.87%), Pampangueno (13.11%) and Bicolano (13.04%) are the top three languages with the most translations. Current efforts are focused on validation and deduplication of translations. There is still a need to intensify crowdsourcing efforts to populate the database and to include translation of terms from the Core Problem List Subset of SNOMED CT.

Conclusion: A standardized medical vocabulary will be useful for integrating to patient information in the vernacular with EMR implementations. This will be also be useful for searching knowledge databases such as MEDLINE/PubMed for retrieving of journal citations. Crowdsourcing leverages the medical community around this effort in a highly mobile phone-using population. Future directions include linking the vocabulary to a database of reference images of medical conditions to enhance its usefulness as a clinical reference.

The Effects of amHealth Intervention on Asthma Symptom Control in Inner-City Teens

Lola Awoyinka^1
1Center for Health Enhancement System Studies, University of Wisconsin

Journal MTM 1:4S:27, 2012
DOI:10.7309/jmtm.49

Abstract

Smartphone based technology has emerged as a promising tool for facilitating behavioral change and promoting healthy choices. CHESS, an extensively investigated eHealth system designed to provide information, support, and decision making tools for individuals was adapted for smartphones and tailored for use by teens with a current diagnosis of asthma. The M-CHESS (Mobile asthma Comprehensive Health Enhancement Support System) application provided periodic asthma education, case management, an asthma action plan, and access to peers with the primary goal of helping the participants learn to better control their asthma symptoms.

218 inner-city adolescent Medicaid recipients were enrolled into the study. Participants were randomized to either a control group (n = 87) which received a smartphone and access to an asthma education website or to an intervention group (n = 131) that received a smartphone preinstalled with M-CHESS. Surveys – including the Asthma Control Test (ACT), a measure of how well an individual’s asthma symptoms are being managed – were administered throughout the intervention period to both the control and M-CHESS teens via the smartphones.

Initial analysis shows a significant effect of M-CHESS on the change in ACT scores across the first 60 days on study (p=.011). On average, the M-CHESS group showed a 2% improvement in ACT score per day of study over the control group. There was no significant difference between groups on the change in ACT score from month 2 to month 4. These results indicate that M-CHESS may be an effective intervention for teens who have trouble controlling their asthma symptoms. Ongoing analysis will examine whether the drop-off in improvement of symptom control is related to a decline in use of the M-CHESS application and attempt to identify specific subgroups for which M-CHESS may provide the greatest benefit in asthma symptom control.

Mobile phone ownership and widespread mHealth use in 168,231 women of reproductive age in rural Bangladesh

Alain B. Labrique,¹Shegufta S. Sikder,¹Sucheta Mehara,¹ LeeWu,¹ Rezwanul Huq,²  Hasmot Ali,²  Parul Christian,¹  Keith West^1
1 Department of International Health, Johns Hopkins Bloomberg School of Public Health. 615 N. Wolfe St., Baltimore ² The JiVitA Maternal and Child Health Project. Godown Road, Poschim Para, Gaibandha Bangladesh

Journal MTM 1:4S:26, 2012
DOI:10.7309/jmtm.48

Abstract

As part of a rapid cross-sectional assessment of vital and health status among a cohort of approximately 650,000 people tracked under surveillance in a decades-long community research population, we sought to collect data on two critical mHealth indicators, in a typical rural South Asian setting. Between January and May 2012, field workers visited 143,239 households and interviewed 168,231 women of reproductive age. Of this, data on 37,979 has been entered, and is presented here. Women aged 15 to 45 were asked about household working phone ownership and their use of mobile phones during an emergency health situation (such as to call for medical advice, call a health provider, arrange transport, or ask for financial support). We found that 71% of surveyed women (n=25,577) reported household ownership of at least one working mobile phone, while 29% (n=10,577) of women reported none. Irrespective of phone ownership, 20% of all women surveyed (n=7,244) reported using a mobile phone for an emergency health situation. Of these women who used a phone for emergencies, 85% (n=6,169) owned a household phone. Women who owned phones were 2.8 times more likely (95%CI: 2.6 – 3.0) to use a phone for an emergency health situation than those who did not own phones. Surprisingly, household electricity was not a barrier to phone ownership or use, as only 23% (n=8,720) of surveyed women reported having electricity. In the absence of formal mHealth systems, nearly a quarter of women reported using a phone during an emergency health situation. This reflects a promising opportunity to harness these ubiquitous systems to inform, educate, and connect vulnerable women in rural populations to advice and care, when and where needed. mHealth interventions should still consider equity gaps that may persist in access to mobile phones in rural communities in South Asia, although ownership should not be a pre-requisite for access, given the current degree of penetration of mobile technology