Technology

Phillips Develops The iPill

11/11/2008 , 10:16 AM by Alex Sicre

Sorry to have been off on posting over the last week. I came across this article in Reuters that I found interesting, and slightly scary. We want develop the best method for increasing medication adherence, but is this the way?

What do you think?

AMSTERDAM (Reuters) – Dutch group Philips has developed an “intelligent pill” that contains a microprocessor, battery, wireless radio, pump and a drug reservoir to release medication in a specific area in the body.

Philips, one of the world’s biggest hospital equipment makers, said Tuesday that the “iPill” capsule, measures acidity with a sensor to determine its location in the gut, and can then release drugs where they are needed.

Delivering drugs to treat digestive tract disorders such as Crohn’s disease directly to the location of the disease means doses can be lower, reducing side effects, Philips said.

While capsules containing miniature cameras are already used as diagnostic tools, those lack the ability to deliver drugs, Philips said.

The “iPill” can also measure the local temperature and report it wirelessly to an external receiver.

The company plans to present the “iPill” at the annual meeting of the American Association of Pharmaceutical Scientists (AAPS) in Atlanta this month.

The iPill is a prototype but suitable for serial manufacturing, Philips said.

(Reporting by Niclas Mika; Editing by Greg Mahlich)

Another Home Robot to Improve Medication Adherence

10/14/2008 , 10:09 AM by Alex Sicre

I found this blurb in the Journal of Telemedicine and Telecare about another home robot to improve medication adherence:

“We have developed a prototype home robot to improve drug compliance. The robot is a small mobile device, capable of autonomous behaviour, as well as remotely controlled operation via a wireless datalink. The robot is capable of face detection and also has a display screen to provide facial feedback to help motivate patients and thus increase their level of compliance. An RFID reader can identify tags attached to different objects, such as bottles, for fluid intake monitoring. A tablet dispenser allows drug compliance monitoring. Despite some limitations, experience with the prototype suggests that simple and low-cost robots may soon become feasible for care of people living alone or in isolation.”

Like my previous post about the Carebot, this is pretty creepy, but it can be the future of home eldercare. Think of I, Robot. I do not see how this can work right now, unless a trust level is developed between the patient and the robot. I can imagine a patient ignoring the robot, unless the patient is already engaged in their medication regime, and needs the help to remember.

I’ll be interested to see how this rolls out and how their clinical trials improve medication adherence.

Text Messaging’s Healthcare Applications

09/30/2008 , 9:13 AM by Alex Sicre

One of the topics I enjoy talking about in regards to Health 2.0 is the effect text messaging will have on healthcare. Intelecare already uses (and has used for 3 years) text messaging as one of the delivery methods for our patient /caregiver created medical adherence reminders. BJ Fogg at Stanford held a Texting4Health conference in February, where a number of uses for texting in healthcare were presented, such as texting for AIDS testing clinics, and a smoking cessation program. Other companies, such as WellSphere, are also using texts as way to transmit health related information – such as where you can find a health food store or gym in your immediate area.

I have been looking at trends in mobile advertising and text usage, but I didn’t really think that it had reached this point.


According to eMarketer: “The average mobile subscriber in the US sent and received more SMS text messages than mobile telephone calls during Q2 2008, according to Nielsen. This was the second consecutive quarter in which the average number of text messages was significantly higher than the average number of phone calls.”

This is simply outstanding. As you can see from the chart, it is not just the tweens and Millenials using texts. My X Generation still sends more texts, and the 56 + crowd even does it. The US is also still way behind the rest of the world.

Quick Story: In 1999 or 2000 I was on a ski trip with my half-brother, Ricardo, who grew up and lives in London. He was looking at his phone and punching buttons (he was 18 or so at the time). I asked what he was doing, and he said “texting my friends”. I asked what that was, he explained, and I said “why don’t you call them”? His answer was that it was simpler, cheaper, and he can do it on “the sly”.

It took me up until last year to really embrace sending text messages. I started with simple texts like “running late” or “what are you up to”, which led to more complicated answers to queries, directions, twitter updates, etc… Now instead of “call me” it is “text me”.

The uses in healthcare, for me, are most readily available for tracking information like glucose readings (I think SugarStats uses this), blood pressure monitoring, etc… I don’t think texting your physician will catch on so rapidly, but it can happen.

AJ Fortin has a great post from this spring: 101 Things to Do With A Mobile Phone in Healthcare.

What are other uses you can think of for texting in healthcare? Please add your comments!

iGuard Medication Alerts

09/18/2008 , 9:29 AM by Alex Sicre

Do you know about iGuard? I never want to sound like a salesperson, but it is a great service “launched in 2007 as a startup venture funded by Quintiles Transnational…to promote better communication and research about drug safety.” Huh? A little bit of hype, and you wonder, how are they going to do that?

On the surface, iGuard is a DDI checker, “a healthcare service that helps monitor the safety of your medications (including prescription drugs, over-the-counter drugs, nutritional supplements and herbal extracts)” like ePocrates, DoubleCheckMD and PharmaSurveyor, but has a lot of other benefits as well. FD I know and have spoken with representatives from all of these companies – and they all do more than just check for drug interactions. I am just placing them in this category for now.

I signed up for iGuard a few months back, seeing if there was any synergy with Intelecare and kind of forgot about it, as I know the drugs I take do not have any interactions with each other. A few days ago I was twittering about another Health 2.0 company, and a VP of Quintiles pinged me to ask if I had heard of iGuard. I replied I had an account and went back to look at it again.

Users add the medications they are taking, and their health problems to see if there are any side effects, and then can get information about said meds and conditions. The interface for the medications is very user friendly with Wikipedia content, prescribing info, indications, fact & figures, side effects, as well as charts based on other users on the same drug and feedback from other patients.

For Niaspan ER, the health information is very straight forward: “This product is used in the treatment of patients with high lipid levels (including cholesterol). It’s exact mechanism of action is not well understood.” I did not know that researchers and MDs did not know how Niaspan works! Learning already. My risk rating is 2, meaning no harmful long-term side effects or interactions. 2,630 patients using iGuard take Niaspan, 53% have side effects (flushing being the most common), 7.0 satisfaction score (mine is a 9), etc… Point being, lots of great information, and a anonymous comment board to post.

This is what got me thinking about them today however, an email from them that stated the FDA is stopping the import of medicines from Ranbaxy Laboratories due to the concerns they are not following US standard for good manufacturing practices. Here is part of the email:

“Although Tricor is one of the medications manufactured by Ranbaxy, drug shortages are not expected because, in most instances, there are enough other suppliers that can help meet demand for Tricor.

For more information, please visit:

http://www.fda.gov/cder/drug/infopage/ranbaxy/qa.htm

* * * *
WHAT DOES THIS MEAN?

This alert will have very little impact on most patients. However, you should be aware that your pharmacy may dispense Tricor manufactured by a different generic company the next time you get your prescription filled.  The effectiveness and safety of generic medication is equal, but some tablets or capsules look different depending on the manufacturer. If your prescription ever looks different, it is always a good idea to ask your pharmacist why the tablets or capsules look different.

This alert is not related to any safety concerns with Ranbaxy products currently distributed in the United States. If you are using medicine covered by this alert you should continue to take it as directed – the risk of suddenly stopping this medication is likely to be greater than any risk associated with their manufacturing. If you have any additional questions about how this FDA alert affects your medications, please talk with your pharmacist.”

I got this email at 7:45 pm last night, after I had “shut down” for the day – and stopped inputing information via the web. I read this around 11 pm and thought wow, this is great. Of course I could get this news with the information I read throughout the day, however it was presented to me before the news broke, and provided me with a calm, knowing that I would be OK with my Tricor.

Another Report On QuiqMeds

08/06/2008 , 11:48 AM by Alex Sicre

I feel like I am becoming a cheerleader or spokesperson for QuiqMeds, without even seeing it in action. In any case, I have nothing to do with the company, but I think it is a neat technology /device that allows for patients and caregivers to get their medications at the doctor’s office and eliminate that step of going to the pharmacy.

As I can attest second hand, when my wife takes our kids to the pediatrician and gets a script, she doesn’t go directly the pharmacy unless it is on her way home (which it is not). Even if she leaves the kids with the nanny and gets her own script from her MD, chances are it will sit in the car, her purse or drawer for at least two or three days.

With QuikMeds, the doctor can dispense medications from a machine with a few touches of a screen. I have some problems with this, but I assume that he company has already taken security, and compliance measures into account. My worries being the “freshness” of the medications, the waste of the medications not filled, the accuracy, etc… All the issues that arise without the human touch of a pharmacist – plus the trust that the medication is the proper medication.

Can I trust that the person who checked the machine and loaded the meds is not a junkie or thief who replaced all the narcotics with OTC generic headache pills? Maybe they do not even dispense these types of meds? That being said, I will check into the company and try to get a demonstration.

Here is a link to a short article and the video of a story that ran last week on CBS 3.

A Video Game Improves Behavioral Outcomes in Adolescents and Young Adults With Cancer: A Randomized Trial

08/01/2008 , 11:52 AM by Alex Sicre

BONUS Medication adherence abstract! From the AAP:

OBJECTIVE.
Suboptimal adherence to self-administered medications is a common problem. The purpose of this study was to determine the effectiveness of a video-game intervention for improving adherence and other behavioral outcomes for adolescents and young adults with malignancies including acute leukemia, lymphoma, and soft-tissue sarcoma.

METHODS.
A randomized trial with baseline and 1- and 3-month assessments was conducted from 2004 to 2005 at 34 medical centers in the United States, Canada, and Australia. A total of 375 male and female patients who were 13 to 29 years old, had an initial or relapse diagnosis of a malignancy, and currently undergoing treatment and expected to continue treatment for at least 4 months from baseline assessment were randomly assigned to the intervention or control group.

The intervention was a video game that addressed issues of cancer treatment and care for teenagers and young adults. Outcome measures included adherence, self-efficacy, knowledge, control, stress, and quality of life. For patients who were prescribed prophylactic antibiotics, adherence to trimethoprim-sulfamethoxazole was tracked by electronic pill-monitoring devices (n = 200). Adherence to 6-mercaptopurine was assessed through serum metabolite assays (n = 54).

RESULTS.
Adherence to trimethoprim-sulfamethoxazole and 6-mercaptopurine was greater in the intervention group. Self-efficacy and knowledge also increased in the intervention group compared with the control group. The intervention did not affect self-report measures of adherence, stress, control, or quality of life.

CONCLUSIONS.
The video-game intervention significantly improved treatment adherence and indicators of cancer-related self-efficacy and knowledge in adolescents and young adults who were undergoing cancer therapy. The findings support current efforts to develop effective video-game interventions for education and training in health care.

Would You Trust Your Eldercare To A Robot?

07/18/2008 , 11:28 AM by Alex Sicre

I came across a GeckoSystems Press Release and found these quotes regarding their CareBots. It is kind of spooky to think this will become a reality. They speak of it as if it is. Thought you might like to read about it:

The consumer has needs for family care assistance with remote monitoring and notification. This is for family care for the elderly, chronically ill, and children. Since GeckoTrak™ enables the CareBot to automatically follow a designated care receiver using sensor fusion, it allows the care giver to remotely see how they are doing using the onboard wireless webcam. Should the designated family member not respond to our CareBot’s inquiries the caregivers would be contacted by GeckoChat™ forthwith by telephone.

Professional healthcare needs cost effective night time errand running, portable telemedicine, etc., enabling specialist nurses to be more efficient and productive with less work by allowing them to video conference (telepresence) doctors for more timely, “on the spot,” diagnosis of patients. The CareBotPro™ can carry all the specialized supplies and equipment the IV or wound care nursing specialists might need. At night the MSR can deliver bed pans, medications, even take vital signs, etc. to those in need while the night shift nurses are busy with a crisis, or other important duties on their wing or floor.

For a non technical discussion of what a GeckoSystems’ CareBot does, the short answer is that it decreases the difficulty and stress for the caregiver that needs to watch over grandma, mom, or other family members most, if not much, of the time day in and day out due to concerns about their well being, safety, and security.

Much like these useful and cost effective appliances, a CareBot helps the care giver as a new type of labor saving, time management automatic home appliance.

For example, time stress is frequently felt by the care giver when they need to go shopping for 2 or 3 hours, and are uncomfortable when they have to be away for more than an hour or so. Time stress is much worse for the caregiver with a frail elderly parent who must be reminded to take medications at certain times of the day. How can the care giver be away for 3-4 hours when Grandma must take her prescribed medication every 2 or 3 hours? If the caregiver is trapped in traffic for an hour or two beyond the 2 or 3 they expected to be gone, this “time stress” can be very difficult for the caregiver to moderate.

Not infrequently, the primary caregiver has a 24 hour, 7 days a week responsibility. After weeks and weeks of this sometimes tedious, if not onerous routine, how does the caregiver get a “day off?” To bring in an outsider is expensive (easily $75-125 per day for just 8 hours) and there is the concern that medication will be missed or the care receiver have an accident requiring immediate assistance by the caregiver, or someone they must designate. And the care receiver may be very resistant to a “stranger” coming in to her home and “running things.”

So what is it worth for a care receiver to have an automatic system to help take care of Grandma? Just 3 or 4 days a month “off” on a daylong shopping trip, a visit with friends, or just take in a movie would cost $225-500 per month. And that scenario assumes that Grandma is willing to be taken care of by a “stranger” during those needed and appropriate days off.

So perhaps an automatic care giver, a CareBot, might be pretty handy, and potentially very cost effective from the primary care giver’s perspective.

The care receiver’s perception of a CareBot is much different from the care giver’s. It’s a new kind of companion that always stays close to them enabling family and friends to care for them from afar. It tells them jokes, retells family anecdotes, reminds them to take medication, reminds them that family is coming over soon (or not at all), recites Bible verses, plays favorite songs and/or other music. It alerts them when unexpected visitors, or intruders are present. It notifies designated care givers when a potentially harmful event has occurred, such as a fall, fire in the home, or just not found by the CareBot for too long a time. And it responds to calls for help and notifies those that the caregiver determined should be immediately notified when any anticipated event occurs.

The family can customize the personality of the CareBot. The voice’s cadence can be fast or slow. The intonation can be breathy, or abrupt. The voice’s volume can range from very loud to very soft. The response phrases from the CareBot for recognized words and phrases can be colloquial and/or unique to the family’s own heritage. The personality can range from brassy to timid depending on how the care giver, and others appropriate, chooses it to be.

Generally, the care receiver is pleased at the prospect of family being able to drop in for a “virtual visit” using the onboard webcam and video monitor for at home “video conferencing.” The care receiver may feel much more needed and appreciated when their far flung family and friends can “look in” on them any where in the world where they can get broadband internet access and simply chat for a bit.

Why is Grandma really interested in a CareBot? She wants to stay in her home, or her family’s home, as long as she possibly can. What’s that worth? Priceless. Or, an average nursing home is $5,000 per month for an environment that is too often the beginning of a spiral downward in the care receiver’s health. That’s probably $2-3K more per month for them to be placed where they really don’t want to be. Financial payback on a CareBot? Less than a year- Emotional payback for the family to have this new automatic caregiver? Nearly instantaneous.

Improving medication adherence with a targeted, technology-driven disease management intervention

07/16/2008 , 10:36 AM by Alex Sicre

I found this abstract in NCBI: Pub Med from a BCBS of South Carolina study. The results definitely support our Adherence 2.0 model. The question is, should mail order pharmacies start sending refills if they are due? I know several pharmacies have auto-fill programs, but should there be a triggering mechanism that gets the refills out the door after a week?

I transfered a refill online at a big box retailer to check out their pharmacy services, and did not get around to picking it up for three weeks (I sent the refill early, and my wife had our second son the day after I sent the request). I went to pick it up, and the meds had been put back. They said it would be an hour wait, so I came back the next day.

I understand why they returned the meds, but there wasn’t any contact to me – no one reached out. They had my email and telephone number, and I was signed up for their reminder program – but I received no notice. This not only lost the pharmacy money, but contributed to my non-adherence.

Would a community pharmacy have made a personalized call to let me know the script was sitting there? Should I have paid more for that service instead of opting for the “deal” at the big box? Should my health plan have been in the mix? These are all questions a patient has to decide for themselves, and the industry needs to think about.

From Pub Med:

Treatment adherence is critical in managing chronic disease, but achieving it remains an elusive goal across many prevalent conditions. As part of its care management strategy, BlueCross BlueShield of South Carolina (BCBSSC) implemented the Longitudinal Adherence Treatment Evaluation program, a behavioral intervention to improve medication adherence among members with cardiovascular disease and/or diabetes.

The objectives of this study were to 1) assess the effectiveness of telephonic intervention in influencing reinitiation of medication therapy, and 2) evaluate the rate and timing of medication reinitiation. BCBSSC applied algorithms against pharmacy claims data to identify patients prescribed targeted medications who were 60 or more days overdue for refills. This information was provided to care managers to address during their next patient contact.

Care managers received focused training on techniques for medication behavior change, readiness to change, motivational interviewing, and active listening. Training also addressed common barriers to adherence and available resources, including side effect management, mail order benefits, drug assistance programs, medication organizers, and reminder systems.

Overdue refills were tracked for 12 months, with medication reinitiation followed for an additional 3 months. In the intervention group, 94 patients were identified with 123 instances of late medication refills. In the age- and gender-matched comparison group, 61 patients were identified with 76 late refills.

The intervention group had a significantly higher rate of medication reinitiation (59.3%) than the control group (42.1%; P < 0.05). Time to reinitiation was significantly shorter in the intervention group, 59.5 (+/- 69.0) days vs. 107.4 (+/- 109) days for the control group (P < 0.05).

This initiative demonstrated that a targeted disease management intervention promoting patient behavior change increased the number of patients who reinitiated therapy after a period of nonadherence and decreased the time from nonadherence to adherence.

50 Web Apps to Help with Your Health

06/03/2008 , 10:33 AM by Alex Sicre

I was reviewing some twitter feeds and Matt C mentioned this link for 50 Web Apps in the Health 2.0 space. Many great web apps are not mentioned, but this is a good place to start!

Cincinnati Children’s Hospital Texting For Health

05/22/2008 , 9:59 AM by Alex Sicre

There have been a couple of articles written about the Cincinnati Children’s Hospital text messaging for medical adherence program.

Here is one from the Cincinnati Enquirer.

And the Yahoo! pick-up of Lauran Neergaard’s AP article.

Nothing really to comment on, except that it is great to see other’s catching on to what we have been doing for three years!

Older Posts »