DIRETOR: TIAGO FERNANDES
DISCIPLINA: INGLÊS INSTRUMENTAL
PROFESSOR (a): SAMYLLA B. A. ARAUJO
ALUNO (a):
Impact of personalized text messages from pharmacists on
medication adherence in type 2 diabetes in France: A real-world,
randomized, comparative study
Abstract
Objective
A real-world, randomized study assessing the impact of a new, personalized,
pharmacist-led text messaging service for managing type 2 diabetes (T2D).
Methods
Messages were tailored to patient’s needs based on their disease management
habits, propensity for reactance, and physical activity levels at baseline. Treatment
adherence (assed using the Morisky Medication Adherence Scale, MMAS-8,
questionnaire), clinical factors (body mass index and physical activity) and biological
markers for T2D were compared between patients who received a text message daily
for 3 months in addition to standard care (SMS group) and those who received
standard care alone (control group).
Results
114 pharmacies recruited 499 patients. Greater increases in global MMAS-8 scores
were observed after 3 months for the SMS group than for the control group,
however, this improvement was not sustained after the text messages stopped. Body
mass index was found to improve with the text messaging service.
Conclusion
This study indicated that personalized text messages provided by community
pharmacists can have an impact on adherence levels among T2D patients.
Practice implications
Pharmacy-led innovations, such as text messaging services, could be used to
accompany patients in their treatment and to improve patient understanding of their
illness between healthcare appointments.
Introduction
Diabetes is a chronic disease that is increasing in prevalence worldwide, with the
number of diabetic adults (all types of diabetes combined) having tripled over the
last 20 years. In France, more than 3.3 million people were pharmacologically
treated for diabetes in 2015, corresponding to 5% of the population, with estimated
medical costs of over €8.5 billion .
The treatment of type 2 diabetes (T2D) aims to control blood glucose levels through
lifestyle changes and pharmacologic treatment. This control is crucial, as it reduces
the incidence of complications, such as kidney disease, which account for more than
50% of the direct healthcare costs . However, nonadherence to medication is a
common problem, which may, at least partially, account for the finding that 41% of
T2D patients in France treated with oral antidiabetic drugs or GLP1 (Glucagon Like
Peptide 1) do not meet the goal of maintaining glycated hemoglobin (HbA1c) levels
below 7%. This can lead to serious consequences, with increases in mortality rates
and increased healthcare spending on diabetes by almost twofold .
Many studies have shown that certain socioeconomic factors are associated with
nonadherence, such as lower income and education levels. Other factors that have
been identified include perceived treatment efficacy, medication beliefs, treatment
complexity, and physician trust, as well as patient forgetfulness and levels of
depression and anxiety.
Various strategies involving health care professionals have been developed to reduce
nonadherence to medication, including patient education programs and intensive
behavioral support. However, improvements have generally been found to be small
and short-lived. Recent approaches have used modern technology, such as mobile
phones, to send automated reminders and information to patients every day, and
there is evidence that this has some success. These systems can be designed so that
messages are especially adapted for each patient, and therefore particular barriers
to medication adherence can be targeted.
In France, around 94% of the population possesses a mobile phone. Thus, the vast
majority of adults can receive text messages, which could be used to remind or
motivate patients concerning their treatment. In this study, we investigated whether
a new pharmacist-led, text messaging service could improve medication adherence
for patients with T2D in France. We also examined whether there was any effect of
text-messaging on biological markers for diabetes, such as HbA1c and high-density
lipoprotein (HDL) cholesterol, and we assessed whether any improvements continued
after the text messages had stopped.
Section snippets
Study design and setting
This interventional, real-world, randomized, comparative study (the INODIAB study)
was carried out in dispensing pharmacies throughout France. The pharmacies
involved were considered to be representative of the 22 534 dispensing pharmacies
in France in terms of their geographical distribution and turnover. The study ran
from May 2015 until August 2016, and patients were recruited between September
2015 and February 2016. Participation in the study did not require patients to make
any additional
Study participants
A total of 114 pharmacies participated in the study. The geographical distribution
and the size of the pharmacies were considered to be representative of French
pharmacies.
In total, 509 patients were recruited for the study: 260 in the SMS group and 249 in
the control group (Fig. 1). Ten patients were excluded, and the remaining 499
patients formed the full analysis set (FAS) and were assessed at 0 M. Overall, 59.3%
of the patients (n = 296) took part in the assessment at 6 M. Of the patients
Discussion
This real-world comparative study indicated that a new text messaging service
delivered by pharmacists could help to improve medication adherence in patients
with T2D in France. Patients who received the individually tailored text messages for
three months showed improved medication adherence compared to the control
group, although this improvement was not sustained following a three-month gap
with no further messages. Other measures (HbA1c, HDL cholesterol, and physical
activity levels) were...
Authors contribution
Jean-François Gautier: Conceptualization, Methodology
Christian Boitard: Conceptualization, Methodology
Yves Michiels: Conceptualization, Methodology, Validation, Formal analysis,
Supervision
Gerard Raymond: Conceptualization, Methodology
Geoffroy Vergez: Conceptualization, Methodology, Validation, Resources,
Supervision, Funding acquisition
Gersende Guedon: Conceptualization, Methodology, Validation, Investigation, Project
administration
Financial support
The first phase of the study (methodology) was supported by funding
from l’Association AXA Prévention.
Informed consent and patient details
The authors confirm all patient/personal identifiers have been removed or disguised
so the patient/person(s) described are not identifiable and cannot be identified
through the details of the story.
Declaration of Competing Interest
The authors report no declarations of interest.
Acknowledgments
Medical writing services were provided by Drs Jessica Freeland, Emma Pilling, and
Marielle Romet (Santé Active Edition). The text messages were written by Edu Santé
(Paris) with help from Bertrand Guillot (Hauteurs Edition, 133 rue du Mont Cenis,
75018, Paris).
Exercícios
1 - Responda:
a) O que o título lhe sugere?
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b) De onde você acha que este texto foi retirado?
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c) Qual o tipo de texto?
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d) Sobre o que fala o texto?
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e) Retire do texto palavras cognatas:
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f) Retire do texto palavras que sejam falso cognatas e coloque a tradução:
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g) Procure no texto marcadores de ideias:
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2 - Localize em que linhas do texto estão as seguintes informações:
Em qual tópico do texto diz que o índice de massa corporal melhorou com o serviço
de mensagens de texto.
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Em qual tópico do texto diz quem financiou a primeira fase de estudo (metodologia).
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Onde diz o número de participantes total e quantos foram excluídos.
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