Perspectives and Views of Primary Care Professionals regarding a mHealth Intervention to Support Adherence to antidiabetic medication in People with Type 2 Diabetes in Spain: A Qualitative Study (Preprint)

BACKGROUND Type 2 Diabetes (T2D) is a long-term condition affecting 9.3% of people worldwide. People with T2D are at high risk of developing serious complications (e.g., blindness, lower-limb amputations, kidney disease, cardiovascular disease), which reduce their quality of life and life expectancy. Antidiabetic medication, if taken appropriately, is effective in preventing diabetes-related complications. However, 40% of T2D patients do not adequately adhere to their medication regimes. Brief text messages (e.g., SMS) delivered at a wide-scale and low cost via digital health systems represent a promising approach to support medication adherence. However, the views and perspectives of primary care professionals (PCP) regarding this type of intervention have seldom been explored. OBJECTIVE To explore PCPs’ views and perspectives concerning the DiabeText intervention, a new text messaging intervention currently being developed to support medication adherence in people with T2D in Mallorca (Spain). METHODS In this qualitative study, we conducted four focus groups (n=28) and eight semi-structured interviews with a purposive sample of primary care doctors and nurses with previous experience in the provision of healthcare to patients with T2D. Data collection explored the acceptability and usefulness of the DiabeText intervention and the barriers and facilitators to its development and implementation. Data analysis was carried out by researchers independently and discussed in a series of six meetings and a workshop. All data were coded by the lead author following an iterative approach. Initial notes were made, followed by a process of categorization and theme development following Braun and Clark’s methodology. RESULTS Three main themes were identified: 1) text messaging interventions have the potential to effectively support diabetes self-management (DSM); 2) Involving PCP in the intervention would facilitate its design and implementation, and; 3) obtaining evidence supporting the cost-effectiveness is a key prerequisite for large scale implementation of the intervention. PCPs drew on their knowledge and experience treating T2D patients to identify facilitators and barriers for the design and implementation of the intervention. They also made suggestions about the content and format of the text messages. PCPs identified additional areas (diet, exercise, diabetes complications, appointment reminders) that the messaging intervention should address to further support adequate DSM. CONCLUSIONS The DiabeText intervention is perceived as useful and acceptable by PCPs provided its cost-effectiveness. Involving PCPs in the design and implementation of the intervention is a key factor to optimize the potential impact of the proposed intervention.

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Optimal cut-off points for adherence measure among patients with type 2 diabetes in primary care clinics: a retrospective analysis

Therapeutic Advances in Chronic Disease ◽

10.1177/2040622321990264 ◽

2021 ◽

Vol 12 ◽

pp. 204062232199026

Author(s):

Ming Tsuey Lim ◽

Norazida Ab Rahman ◽

Xin Rou Teh ◽

Chee Lee Chan ◽

Shantini Thevendran ◽

...

Keyword(s):

Type 2 Diabetes ◽

Primary Care ◽

Medication Adherence ◽

Poor Adherence ◽

Adherence Measure ◽

Primary Care Clinics ◽

Assessment Period ◽

Hba1c Target ◽

Optimal Adherence

Background: Medication adherence measures are often dichotomized to classify patients into those with good or poor adherence using a cut-off value ⩾80%, but this cut-off may not be universal across diseases or medication classes. This study aimed to examine the cut-off value that optimally distinguish good and poor adherence by using the medication possession ratio (MPR) and proportion of days covered (PDC) as adherence measures and glycated hemoglobin (HbA1c) as outcome measure among type 2 diabetes mellitus (T2DM) patients. Method: We used pharmacy dispensing data of 1461 eligible T2DM patients from public primary care clinics in Malaysia treated with oral antidiabetic drugs between January 2018 and May 2019. Adherence rates were calculated during the period preceding the HbA1c measurement. Adherence cut-off values for the following conditions were compared: adherence measure (MPR versus PDC), assessment period (90-day versus 180-day), and HbA1c target (⩽7.0% versus ⩽8.0%). Results: The optimal adherence cut-offs for MPR and PDC in predicting HbA1c ⩽7.0% ranged between 86.1% and 98.3% across the two assessment periods. In predicting HbA1c ⩽8.0%, the optimal adherence cut-offs ranged from 86.1% to 92.8%. The cut-off value was notably higher with PDC as the adherence measure, shorter assessment period, and a stricter HbA1c target (⩽7.0%) as outcome. Conclusion: We found that optimal adherence cut-off appeared to be slightly higher than the conventional value of 80%. The adherence thresholds may vary depending on the length of assessment period and outcome definition but a reasonably wise cut-off to distinguish good versus poor medication adherence to be clinically meaningful should be at 90%.

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Effects of a tailored text messaging intervention among diverse adults with type 2 diabetes: Evidence from the 15-month REACH RCT

10.2337/figshare.13052981.v1 ◽

2020 ◽

Author(s):

Lyndsay A. Nelson ◽

Robert A. Greevy ◽

Andrew Spieker ◽

Kenneth A. Wallston ◽

Tom A. Elasy ◽

...

Keyword(s):

Type 2 Diabetes ◽

Medication Adherence ◽

Self Efficacy ◽

Text Messaging ◽

Self Care ◽

Baseline Hba1c ◽

Median Response ◽

Text Messaging Intervention

Objective: Text messaging interventions have high potential for scalability and to reduce health disparities; however, more rigorous, long-term trials are needed. We examined the long-term efficacy and mechanisms of a tailored text messaging intervention. Research Design and Methods: Adults with type 2 diabetes participated in a parallel-groups, 15-month randomized trial, assigned to receive REACH (Rapid Education/Encouragement and Communications for Health) for 12 months or control. REACH included interactive texts and tailored texts addressing medication adherence, and non-tailored texts supporting other self-care behaviors. Outcomes included HbA1c, diabetes medication adherence, self-care, and self-efficacy. Results: Participants (N=506) were approximately half racial/ethnic minority and half were underinsured, had annual household incomes <$35,000 USD and ≤ high school education; 11% were homeless. <a>Average baseline HbA1c was 8.6%±1.8%; 70.0±19.7 mmol/mol) with n=219 having HbA1c≥8.5% (69 mmol/mol)</a> and half were prescribed insulin. Retention was over 90%. Median response rate to interactive texts was 91% (interquartile range 75%, 97%). The treatment effect on HbA1c at 6 months (-0.31%; 95% CI [-0.61%, -0.02%]) was greater among those with baseline HbA1c≥8.5% (-0.74%; 95% CI [-1.26%, -0.23%]), and there was not evidence of effect modification by race/ethnicity or socioeconomic disadvantage. REACH improved medication adherence and diet through 12 months, and self-efficacy through 6 months. Treatment effects were not significant for any outcome at 15 months. REACH reduced barriers to adherence, but barrier reduction did not mediate outcome improvements. Conclusions: REACH engaged at-risk patients in diabetes self-management and improved short-term HbA1c. More than texts alone may be needed to sustain effects.

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Quality of Life and Associated Factors among Primary Care Asian Patients with Type 2 Diabetes Mellitus

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16193561 ◽

2019 ◽

Vol 16 (19) ◽

pp. 3561 ◽

Cited By ~ 4

Author(s):

Hardesh Dhillon ◽

Rusli Bin Nordin ◽

Amutha Ramadas

Keyword(s):

Quality Of Life ◽

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Primary Care ◽

Type 2 Diabetes Mellitus ◽

Medication Adherence ◽

Well Being ◽

Care Clinic

Diabetes complications, medication adherence, and psychosocial well-being have been associated with quality of life (QOL) among several Western and Asian populations with diabetes, however, there is little evidence substantiating these relationships among Malaysia’s unique and diverse population. Therefore, a cross-sectional study was conducted in a Malaysian public primary care clinic among 150 patients diagnosed with type 2 diabetes mellitus (T2DM). Structured and validated questionnaires were used to investigate the associations between demographic, clinical, and psychological factors with QOL of the study participants. Approximately three-quarters of patients had a good-excellent QOL. Diabetes-related variables that were significantly associated with poor QOL scores included insulin containing treatment regimens, poor glycemic control, inactive lifestyle, retinopathy, neuropathy, abnormal psychosocial well-being, higher diabetes complication severity, and nonadherence (p < 0.05). The main predictors of a good-excellent QOL were HbA1c ≤ 6.5% (aOR = 20.78, 95% CI = 2.5175.9, p = 0.005), normal anxiety levels (aOR = 5.73, 95% CI = 1.8–18.5, p = 0.004), medication adherence (aOR = 3.35, 95% CI = 1.3–8.7, p = 0.012), and an aDCSI score of one and two as compared to those greater than or equal to four (aOR = 7.78, 95% CI = 1.5–39.2, p = 0.013 and aOR = 8.23, 95% CI = 2.1–32.8, p = 0.003), respectively. Medication adherence has also been found to be an effect modifier of relationships between HbA1c, depression, anxiety, disease severity, and QOL. These predictors of QOL are important factors to consider when managing patients with T2DM.

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DTEXT – text messaging intervention to improve outcomes of people with type 2 diabetes: protocol for randomised controlled trial and cost-effectiveness analysis

BMC Public Health ◽

10.1186/s12889-019-6550-6 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

Karen Waller ◽

Susan Furber ◽

Adrian Bauman ◽

Margaret Allman-Farinelli ◽

Paul van den Dolder ◽

...

Keyword(s):

Type 2 Diabetes ◽

Cost Effectiveness ◽

Randomised Controlled Trial ◽

Text Messaging ◽

Controlled Trial ◽

Cost Effectiveness Analysis ◽

Effectiveness Analysis ◽

Randomised Controlled ◽

Text Messaging Intervention

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Cost-effectiveness analysis of adding pharmacists to primary care teams to reduce cardiovascular risk in patients with Type 2 diabetes: results from a randomized controlled trial

Diabetic Medicine ◽

10.1111/dme.12692 ◽

2015 ◽

Vol 32 (7) ◽

pp. 899-906 ◽

Cited By ~ 21

Author(s):

S. H. Simpson ◽

D. A. Lier ◽

S. R. Majumdar ◽

R. T. Tsuyuki ◽

R. Z. Lewanczuk ◽

...

Keyword(s):

Type 2 Diabetes ◽

Primary Care ◽

Randomized Controlled Trial ◽

Cardiovascular Risk ◽

Cost Effectiveness ◽

Controlled Trial ◽

Randomized Controlled ◽

Effectiveness Analysis ◽

Primary Care Teams

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Five‐year cost‐effectiveness of the Patient Empowerment Programme ( PEP ) for type 2 diabetes mellitus in primary care

Diabetes Obesity and Metabolism ◽

10.1111/dom.12919 ◽

2017 ◽

Vol 19 (9) ◽

pp. 1312-1316 ◽

Cited By ~ 4

Author(s):

Jinxiao Lian ◽

Sarah M. McGhee ◽

Ching So ◽

June Chau ◽

Carlos K. H. Wong ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Primary Care ◽

Type 2 Diabetes Mellitus ◽

Cost Effectiveness ◽

Patient Empowerment

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Can primary care professionals’ adherence to Evidence Based Medicine tools improve quality of care in Type 2 diabetes mellitus? A systematic review

Diabetes Research and Clinical Practice ◽

10.1016/j.diabres.2009.05.007 ◽

2009 ◽

Vol 85 (2) ◽

pp. 119-131 ◽

Cited By ~ 31

Author(s):

A.G. de Belvis ◽

F. Pelone ◽

A. Biasco ◽

W. Ricciardi ◽

M. Volpe

Keyword(s):

Diabetes Mellitus ◽

Systematic Review ◽

Type 2 Diabetes ◽

Primary Care ◽

Evidence Based ◽

Improve Quality ◽

Based Medicine ◽

Primary Care Professionals

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Probabilistic Sensitivity Analysis to Analyze the Cost-Effectiveness of Oral Hypoglycemic Agents in the Initial Oral Drug Treatment of Outpatients Diagnosed with Type 2 Diabetes in Primary Care

Value in Health ◽

10.1016/j.jval.2013.08.2056 ◽

2013 ◽

Vol 16 (7) ◽

pp. A689

Author(s):

C. Diaz de León-Castañeda ◽

C.E. Pinzon-Florez ◽

A. Arredondo

Keyword(s):

Type 2 Diabetes ◽

Primary Care ◽

Sensitivity Analysis ◽

Cost Effectiveness ◽

Probabilistic Sensitivity Analysis ◽

Hypoglycemic Agents ◽

Oral Drug ◽

Oral Hypoglycemic Agents ◽

The Cost

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A Highly Tailored Text and Voice Messaging Intervention to Improve Medication Adherence in Patients With Either or Both Hypertension and Type 2 Diabetes in a UK Primary Care Setting: Feasibility Randomized Controlled Trial of Clinical Effectiveness

Journal of Medical Internet Research ◽

10.2196/16629 ◽

2020 ◽

Vol 22 (5) ◽

pp. e16629 ◽

Cited By ~ 2

Author(s):

Aikaterini Kassavou ◽

Venus Mirzaei ◽

James Brimicombe ◽

Simon Edwards ◽

Efthalia Massou ◽

...

Keyword(s):

Type 2 Diabetes ◽

Primary Care ◽

Randomized Controlled Trial ◽

Medication Adherence ◽

Controlled Trial ◽

Intervention Group ◽

Clinical Effectiveness ◽

Control Group ◽

Randomized Controlled

Background The efficacy of a highly tailored digital intervention to support medication adherence and feasibility to support clinical effectiveness as an adjunct to the primary care setting has not been evaluated. Objective This trial aimed to assess the behavioral efficacy of a highly tailored digital intervention to support medication adherence and to evaluate the feasibility of its clinical effectiveness, in patients with either or both hypertension and type 2 diabetes. We also examined quality of life and mechanisms of behavior change. Intervention fidelity, engagement, and satisfaction were also explored. Methods This was a multicenter, individually randomized controlled trial of 2 parallel groups: an intervention group that received a highly tailored text message and interactive voice response intervention for 12 weeks, and a control group that received usual care. Medication adherence was measured using self-reports and assessor-blinded practice records of a repeat prescription. Systolic blood pressure and glucose levels were assessed by nurses blinded to group allocation during practice visits at 3 months follow-up. Questionnaires obtained data to assess intervention mechanisms of action and satisfaction and digital log files captured data to evaluate fidelity and engagement. Results A total of 135 nonadherent patients (62/135, 46% female; 122/135, 90.3%; aged above 50 years) were randomly allocated in the intervention (n=79) or in the control group (n=56); of whom 13% (18/135) were lost at follow-up. Medication adherence was significantly improved in the intervention group compared with the control group (t116=2.27; P=.02, 2-tailed). Systolic blood pressure was 0.6 mmHg (95% CI −7.423 to 6.301), and hemoglobin A1c was 4.5 mmol/mol (95% CI −13.099 to 4.710) lower in the intervention group compared with the control group. Changes in intentional nonadherence and nonintentional nonadherence explained the improvements in medication adherence in the intervention group (beta=.074, SE=0.464; P=.04), but not in the control group (beta=.00, SE 1.35; P=.37). The intervention had 100% fidelity, a median of 12 days of engagement, and 76% overall satisfaction. Conclusions Our trial is the first that has been conducted in the United Kingdom and showed that among nonadherent patients with either or both hypertension and type 2 diabetes, a highly tailored digital intervention was effective at improving treatment adherence and feasible to obtain clinically meaningful outcomes. Changes in intentional and nonintentional nonadherence predicted the improvements in medication adherence. The intervention had high fidelity, engagement, and satisfaction. Future research using a rigorous design is needed to evaluate the clinical effectiveness and cost-effectiveness of the intervention in primary care. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN) 10668149; http://www.controlled-trials.com/ISRCTN10668149.

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