A personalized medication management platform (PMMP) to improve medication adherence: A randomized control trial
Introduction
In the Worldwide Health Ranking report issued by “The Economist Intelligence Unit” 2007, Taiwan's healthcare system was ranked second to Sweden and followed by Canada among the top 32 developed nations in the world [1]. This led to many European nations taking interest in Taiwan's National Health Insurance (NHI) model, with the American Public Television network visiting Taiwan to produce special programs on the successful implementation of the NHI system [2]. However, Taiwan is becoming an aging society [3] resulting in increased medical treatment costs and treatment complexities of emerging diseases which contribute to substantial increases in NHI expenditures and serious financial pressures. From 2006 to 2012, the average number of outpatient clinic visits ranged from 14.3 to 15.5 annually (Table S1-Appendix) [4], with an average number of drugs at 3.12 to 3.26 per prescription (Table S2-Appendix) [5]. Therefore, due to the high number of medications and complicated regimens, multiple types prescription adherence and medication accuracy have been low, leading to substantial increases in medication costs over the past years [6], [7].
Moreover, limited professional knowledge on drugs among the patients and the high complexity of medications has led to many medication-related problems [8]. Some studies reported that medication adherence was generally poor after most patients were given drugs to take at home due to either being busy or under pressure from work [7]. There were 35%–50% of prescription drugs taken incorrectly [9], with medication compliance inversely related to daily dosage frequency [10]. For the patients with medications once daily, the compliance rate was up to 79% (Fig. S1-Appendix), however, the compliance rate was markedly reduced to 51% for those who needed to take medications four times daily [11], [12], [13], [14] indicating that the increased medication frequency was associated with reduced compliance. On the other hands, many drug categories, complicated medication regimen, and dosing frequency result in poor patient medication adherence. The patients themselves experience difficulties with the meaning of medications and their abbreviations (Table S3-Appendix). The medication dosage frequencies could be up to 144 different types according to different combinations observed by previous study [15]. Therefore, the large quantities of medications in Taiwan are likely to be related to decreased compliance and lower medication accuracy [16], [17].
Previous studies have shown that medication adherence was significantly associated with better treatment outcomes and the effectiveness of physical rehabilitation [7]. Many systematic approaches that could be instituted in improving patient medication compliance have been used to improve treatment outcomes of patients [7], [18], [19]. Appropriate description of disease given by physicians to patients was useful to motivate them to participate in treatment planning and helpful in improving medication compliance and accurate dosage frequency. Good communication with patients and patient-doctor interactions play an important role in improving patient health outcomes [11], [12], [18], [19], [20]. With advances in technology, doctor-patient communications have diversified, primarily, verbal interactions with patients for medication compliance have been largely replaced by Short Message Service (SMS) [21], [22], [23], [24], [25]. A study conducted at the New England Healthcare Institute indicated that the annual healthcare expenses caused by poor medication adherence to particular styles cost a total of USD 290 billion in USA [26]. Therefore, improving medication compliance is a very important issue as it imposes challenges for many countries in the world. The most significant international trend in the healthcare industry is to further develop and improvise the development of Personal Health Record (PHR) with the aid of the EHR [27]. PHR is intended for improving self-management of health records and to reduce patients’ difficulties in accessing information for self-education by using a common platform [28], [29]. The promotion of PHR has been also included in the National Healthcare Informatics Project (NHIP) by the Taiwan Department of Health and Welfare.
In this study, the main objective was to assess whether medication adherence could be increased by using SMS(s) through a personalized medication management platform. The Mobile Personal Medication Management Platform (PMMP) combined with a mobile/smart phone was used as the main system platform. A simple design with human operation interface and innovative service processes in combination with the professional personal medication management template was used to develop a core Rule-Based Engine for medication, in order to support patients with knowledge management and decision making in medication management. The combination of mobile phones and exclusive Pharmacopoeia was used for personalized medication management and as a reminder to further facilitate medication compliance for patients at home.
Section snippets
Technical overview
In a prior study, Jian W. S. presented a method for exchanging Taiwan hospital information which termed as “Taiwan electronic Medical record Template-TMT” [27], also known as “portable electronic medical records”. It collected more than 10,000 medical records from 241 hospitals in Taiwan, constructing an XML-based electronic medical record (EMR) architecture that meets the international standards, HL7 and CDA2.0.
In this study, the PMMP platform integrated the national standards of medical
Results
The present study included 1312 participants from a population of approximately 3687 patients (Fig. 3). After 114 invalid or incomplete questionnaires were removed, the remaining participants were 1198, of which 763 patients (383 male and 380 female) were included in the intervention group and 435 patients (211 male and 224 female) in the control group. The main findings are summarized as follows:
The intervention group received SMS alerts and the control group did not. Most of the participants
Discussion
This study reveals significant differences after the SMS intervention; the number of missed medications in the intervention group declined from 46% to 5%, a 90% improvement, and in the control group they declined from 47% to 17%. Delayed medications in the intervention group declined from 85% to 18% and in the control group they declined from 80% to 43% (Table 2). Specially trained research assistants conducted a follow-up interview 7 days after the intervention. The relatively short
Conflicts of interest
The authors declare none.
Acknowledgments
This work was funded in part by grants DOH100-TDC-111-008 from the Department of Health Taiwan, by grants NSC 99-2218-E-038-001 from the National Science Council Taiwan and by grants MOHW103-TD-B-111-01 fromMinistry of Health and Welfare Taiwan. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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