1. Evaluation of mHealth Intervention in COPD - CareMessage
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Evaluation of mHealth Intervention in COPD - CareMessage
Landon, Chris
Ventura County Medical Center, Ventura, CA, United States.
COPD: 263 participants, 85% retention rate, 20% response rate to questions.We do not know exactly why these
participants have a low response rate; however, a number of factors could be at play - e.g., participants are reading
the messages but do not have time to respond or feel like responding (our user interviews have shown this to be a
common reason for low response rates). Across all CareMessage programs, the average response rate is 42%.
Purpose
Conclusions
Smoking Cessation: 21 participants - 20% response rate 72% retention rate.
Why is there a low response rate? Any measures or interventions?
Account manager from Care Message has stated, “We do not know exactly why these participants have a low response rate; however, a number of factors could be at play - e.g., participants are reading the messages but do not have time to respond or feel like responding (our user interviews have shown this to be a common reason for low response rates). Across all CareMessage programs, the average response rate is 42%.”
 Based on the experience of the CATCH team, low response rate has been contributed to the age of participants. The CATCH COPD program consists mostly of seniors who are not necessarily technologically savvy. Measures:
Outreach and direct messaging utilization to help increase engagement and efficiency - over 45 reminders have been sent about events, support groups, and appointments. The target population is an uncontrollable factor due to the nature of the typical age of COPD patients. Other programs that are focused on a younger population would probably have a higher response rate, such as the statistics shown from the average response rate for CareMessage at 42%.
Retention:
Retention is defined as a participant who does not opt out of the program or is not manually stopped in the program by a staff member. The participant must have completed receiving all of the messaging in the program. Essentially 12% of the participants opted out of the program.
The percentage of health app users who abandon an app after one use is now 23%. But clearly,
with about one in four users still only using an app once, not enough has been done to match what consumers want and restore apps to the success of just a few years ago. The targeted interventions in the specific disease state offered a sub menu of services in COPD education, Nutrition education, Smoking cessation, and stress management appears to result in high retention rate.
The interactive mobile health information service was designed to supplement the standard of care by supporting patient-empowerment strategies through educating participants, encouraging behavior change, and promoting adherence. Through the delivery of the text-based messages to participants, the goal of the intervention is to improve their 1) appointment attendance, 2) medication adherence, and 3) disease self-management behaviors. .
Methods
To conduct the CareMesssage trial a convenience sample of COPD patients assigned to the COPD Access To Community Health (CATCH) were recruited to participate voluntarily. Case Managers informed eligible, potential participants when they first presented to the CATCH Program, and provided them with an informational brochure. The CareMesssage group received and responded to messages, tips, appointment reminders, administrative notifications, and questionnaires.
Stress Management: 145 participants - everyone who was not currently enrolled in another program but was on the
CareMessage platform was enrolled in Stress Management 55% response rate, 95% retention rate.
Outreach and direct messaging utilization to help increase engagement and efficiency - over 45 reminders were sent about events, support groups, and appointments
Results
CATCH program has 273 participants on the platform, out of 1840 enrolled in the CATCH Program, with 4 health education programs in use resulting in 4,815 text messages
Nutrition: 184 participants. Everyone who has completed the COPD program is automatically enrolled into the
Nutrition program. 32% response rate. 88% retention rate . Essentially 12% of the part9cipants opted out of the
Program.
CLINICAL IMPLICATIONS
This technology has been instrumental in maintaining patient engagement and keeping the communication flowing. Key messages are sent out on a weekly basis. CATCH technology is not limited to the occasional text message. Patients also receive s and phone calls, however, the text messaging service has been most efficient. Although only one in eight patients elected to sign up for the program, this selection of motivated
patients should guide the use of health related apps in other disease states as well.
Centers for Medicare & Medicaid Services – Center for Innovations CMS Awardee Number 1C1CMS331320

2. Landon, Chris ; Turner, Ralph CLINICAL IMPLICATIONS
IMPROVING PATIENT ADHERENCE TO COMPLEX MEDICAL REGIMENS THROUGH BLUE TOOTH
ENABLED TECHNOLOGY
Landon, Chris ; Turner, Ralph
. Pediatric Diagnostic Center, Ventura County Medical Center, Ventura , CA, United States.
Abstract
PURPOSE: Real-world adherence to inhaled and oral therapies for cystic fibrosis (CF) patients remains discouragingly low, ranging 31-53% for inhaled antibiotics. Programs to enhance adherence, including comprehensive behavioral interventions with adolescents, have met with mixed success. Blue-tooth enabled technology allows for the advancement of patient medication adherence monitoring and intervention.
METHODS: Open-label pilot study initiated to evaluate treatment adherence by linking treatment and feedback components utilizing the eRapid™ (PARI), a blue tooth- enabled medication delivery device combining eBase Controller with monitoring function with Altera nebulizer handset. Data uploads from the QualComm Life2Net hub to the PARI server where it is downloaded to RedCap data collection. CF clinic patients were screened by the multi-disciplinary team and with the Morisky Adherence Questionnaire (MAQ) for risk of poor adherence. The device was demonstrated and dispensed from clinic following baseline assessment of Pulmonary Exacerbation Score (PES) and pulmonary function along with patient-reported outcomes. Patients participated for 28 days.
RESULTS: 14 subjects aged 8 – 32, 62% female with mean (SD) MAQ 3.0 (2.2), %FEV (.38), and PES 7.8 (5.8). MAQ results indicated 11% adherent and 89% either moderate or non-adherent at baseline. %FEV1 and PES scores indicated significant pulmonary limitation. Initial results from completed patients revealed an 80% improvement in adherence along with 30% improvement in %FEV1 and PES scores. Our team utilized this technology: as a clinic and hospital discharge kit to initiate medication, providing rapid feedback on utilization; as part of a depression intervention with reward for adherence; to manage adherence, bringing compliance in line prior to initiation of Orkambi; as an “adherence booster” after the patient had regressed; and dispensing medication delivery into another culture.
CONCLUSIONS: Initial results indicate that this pilot sample was able to utilize the system effectively. Preliminary change data are encouraging. Further, the device allows active engagement and discussion by the patient and provider of the treatment regimen. Date and time stamped data allowed shared decision making in individualizing therapy for each patients schedule, creating a pathway towards cognitive behavioral therapy intervention. Weekly review of adherence is studied as a process, as opposed to the quarterly team review by patient recall and medication possession by refill data. This additional communication between the patient/family and CF Team addresses the challenges of adhering to CF treatments collaboratively, avoiding miscommunication and misunderstandings about the treatment regimen. Self-report measures of adherence were supplemented by real time data in conjunction with this additional measurement tools.
CLINICAL IMPLICATIONS: For large-scale studies: the device has potential to replace pharmacy refill histories as a feasible measure of adherence; can replace Daily Phone Diaries; provides highly accurate information that can be used with other measures. The pilot study demonstrates that electronic monitors can become the “gold standard” because they can be integrated into delivery systems currently in place
This proof-of-concept open label study was initiated to evaluate a systematic approach by linking treatment and feedback components utilizing the eRapid™ Nebulizer System (PARI), a blue tooth enabled medication delivery
device equipped with eBase Controller with monitoring function with the Altera nebulizer handset. The device utilizes the QualComm Life2Net hub, to PARI server, to Amazon cloud, to RedCap data collection. CF clinic patients were screened by the multi-disciplinary team and with the Morisky Adherence Questionnaire (MAQ) for risk of poor adherence. The device was demonstrated and dispensed from clinic following baseline assessment of Pulmonary Exacerbation Score, pulmonary function, and mental health assessment. Patients used the system as prescribed for four weeks, and evaluated with follow- up PFT, PES, and MAQ.
Patients were trained and used the eRapid system with a minimum of difficulty. Data were successfully transmitted to the clinic and used in ongoing clinical discussions with the patients. Self-reported adherence Improved for the MAQ which was reflected in Improvement in clinician-assessed pulmonary exacerbations. Simulated data based on the pilot study indicated significant associations between albuterol and especially Cayston adherence and the MAQ.
CLINICAL IMPLICATIONS
For large-scale studies, the device has potential to replace pharmacy refill histories as the most feasible measure of adherence. The device can potentially replace Daily Phone Diaries or other EMA strategies (PDA assessment). The device provides highly accurate information that can be used in conjunction with other measures. The pilot study demonstrates that Electronic Monitors can become the “gold standard” because they can be integrated into delivery systems currently in place.
Objectives
To establish and test electronic transfer of device utilization information
To evaluate the eRapid system as an objective measure of patient adherence
To evaluate the use eRapid system data as part of patient communication