An E-Medicine Delivery and Treatment Monitoring Service For Patients With Type-2 Diabetes In The NHS - Project proposal ((ISSN 2753-8176 (online)

An E-Medicine Delivery and Treatment Monitoring Service For Patients With Type-2 Diabetes In The NHS - Project proposal

Ana Pedro 1

1 Gwyntwr1386 Pharmacy, Regus Chester Business Park, Heronsway, Chester, CH49QR, UK

There is a high prevalence of diabetes and it continues to increase. The adherence to oral antidiabetics ranges from 36% to 93% (1). Moreover, improving the adherence to treatment in diabetes patients will lead to a better glycaemic control and could in the longterm reduce the incidence of micro- and macrovascular complications associated with diabetes (2,3). Also, most MCA (medicine-compliance aids) patients are elderly and suffer of combined cardiovascular disease including diabetes (4). Gwyntwr1386 Pharmacy, intends to provide a new, online clinical delivery and treatment monitoring service for the NHS based on a blister-pack and its external medication, a monitoring POC device and a web platform. In an automated fashion, this will deliver medication in a "smart" paper blister package which incorporates an electronic module and printed sensor grid inside the package, both of which are invisible to the patient. The hidden technology records the time, date and location when a dose is removed from the blister package and will be coupled with a POC continuous glucose monitoring device for patients with type 2 diabetes. This system, will improve quality of life and contribute to the observance of treatments as well as the continuous measure of glucose levels, saving time and money in what concerns obtaining clinical data analysis results which will be necessary for clinicians to make decisions about treatment and also assuring the correct and adjusted medication is taken properly. Also, it will help to find out when it is necessary to arrange a new face to face appointments with Doctors or other healthcare professionals. This development is logistically robust as the the blister-pack technology is currently already in use within NHS (4). The continuous glucose monitoring is based also on technology that has been tested for use including at the NHS (5-7). In an additional important development both the medicine taking by the patient and glucose monitoring will be transmitted via a Wifi enabled communicating device app to healthcare practitioners, to the patient or the carer by SMS alerts and emails and all the information will be automatically integrated on an online platform which allows to monitor patient compliance. These practitioners can be pharmacists or the attending physician or social workers either in a community pharmacy or hospital or GP surgery or care home or at home care. Subsequently, this clinical data will be transferred to the central electronic patient health record. Ana Pedro, will coordinate this project and will need access to the digital blister pack system and to technical help in terms of hardware and software development to couple the glucose testing device to the digital blister pack. Both the digital blister-pack and POC testing device have been fully developed and have published efficacy data (4, 6-7) however we would like to ascertain the feasibility of both systems together in terms of likely patient benefits. For this reason, the outcomes of treatment (fidelity (8), adherence (9) and acceptability (10), efficacy (11), adverse reactions (12), costs (13)) will be measured by comparing a group of 18 patients using the digital blister-pack+POC test system with a group of 18 patients receiving the standard treatment (treated with the drugs and standard glucose meters). We will ascertain if our new system is truly less costly compared with the traditional system. Moreover, after this diabetes service is set up, we aim to develop this same service for other chronic diseases as well as for infectious diseases and for oncologic diseases as well as for emergency situations and to any patient who gets registered with a GP surgery whether has an illness or not.

REFERENCES

1. Cramer JA: A systematic review of adherence with medications for diabetes. Diabetes Care 2004, 27:1218-1224.

2. Dailey GE III: Improving oral pharmacologic treatment and management of type 2 diabetes. Manag Care 2004, 13:41-47.

3. Rozenfeld Y, Hunt JS, Plauschinat C, Wong KS: Oral antidiabetic medication adherence and glycemic control in managed care. Am J Manag Care 2008, 14:71-75

4. Pedro A. “The use of Multi-compartment Compliance Aids (MCAs) in Pharmacies in England and North Wales”. Preprints. doi 10.20944/preprints202007.0541.v1. July 2020

5. https://www.freestyle.abbott/uk-en/products/freestyle-libre-2.html

6. Vervloet et al. BMC Health Services Research 2011, 11:5

7.Vervloet et al. Int J Med Inform 2012, 594-604

8.The Assessment, Monitoring, and Enhancement of Treatment Fidelity In Public Health Clinical Trials. Borreli B. J Public Health Dent. 2011 WINTER; 71(s1): S52–S63.

9.Barriers and facilitators to medication adherence: a qualitative study with general practitioners. Kvarnström K, Airaksinen M, Liira H.BMJ Open. 2018 Jan 23;8(1):e015332. doi: 10.1136/bmjopen-2016-015332.

10.Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework. Mandeep Sekhon, Martin Cartwright, Jill J Francis. BMC Health Serv Res. 2017 Jan 26;17(1):88.

11.A Primer on Effectiveness and Efficacy Trials. Amit G Singal, Peter D R Higgins, and Akbar K Waljee. Clin Transl Gastroenterol. 2014 Jan; 5(1): e45.

12.Eliciting adverse effects data from participants in clinical trials. Elizabeth N Allen, Clare IR Chandler, Nyaradzo Mandimika, Cordelia Leisegang, Karen Barnes. Cochrane Systematic Review – Methodology, Version published: 16 January 2018

13.Does use of point-of-care testing improve cost-effectiveness of the NHS Health Check programme in the primary care setting? A cost-minimisation analysis. Austen El-Osta, Maria Woringer, Elena Pizzo, Talitha Verhoef, Claire Dickie, Melody Z Ni, Jeremy R Huddy, Michael Soljak, George B Hanna, Azeem MajeedBMJ Open. 2017; 7(8): e015494.

14. Pedro A (2022). “An E-Medicine Delivery and Treatment Monitoring Service For Patients With Heart Disease In The NHS” - Project proposal ISSN 2753-8176 (online) (DOI:10.13140/RG.2.2.34395.03360)