Transcript pharmacie 59

Recruitment & Enrollment of Older Adults into Mobile Phone
Text Message Clinical Trials
S. L., Sikorskii, A., Given, C. W., Coursaris, C. K., Majumder, A., Schueller, M., DeKoekkoek, T., Given, B
BACKGROUND
RESULTS
 90% of adults in the US have cell phones
o 81% use their phone to text message
 Text messages are easy-to-use &
inexpensive means of delivering behavioral
interventions to improve health outcomes
 The therapeutic outcome of cancer
treatment for patients taking Oral Agents
(OAs) depends on self-management
o Patients spend less time in cancer clinics
o Less opportunity for participation in
research
 59% of those w/cancer >65 years of age
 Cancer clinics VS Specialty Pharmacy:
o Screened: 293 to 169
o Eligible: 43% to 72%
o Consented 56% to 74%
 97.1% satisfaction with text messaging
 94% thought texting was helpful
 Limitations:
o Recruitment:
 Cancer clinic in person
 Specialty Pharmacy by phone or letter
o May be confounding factor
PURPOSE
 Contrast characteristics and health status
o Adults with cancer
 Screened/enrolled into text message RCTs
 At specialty pharmacy versus cancer clinics
METHODS
 Data from two RCTs
o Examined efficacy of text messaging
o On medication adherence
o Adults on oral anti-cancer agents
 Recruited from:
o 5 community-based cancer clinics
o 1 national specialty pharmacy
 Randomized:
 Text message intervention
o Timed to medication regimen
o 21-28 days
 Usual care control group
 Stats: chi-square, Fisher’s exact, t-tests, GLM
 Examined by settings:
 Specialty Pharmacy
 VERSUS
 Cancer Clinics
CONCLUSIONS
RESULTS
 >20 types of cancer
 28 different oral anti-cancer agents
 No differences Specialty Pharmacy to
Clinics:
o Age 60.25 (SD 10.68) to 57.85 (SD 10.44)
o Sex; Ethnicity
o Employment status
 Specialty Pharmacy participants were:
o > African Americans p=0.02
o > educated 60% to 44.12% p=0.02
o Later stage disease p=.01
o More ill:
 > number of symptoms p<.01
 > symptom severity p=.02
 > symptom interference p=.01
 No differences regimen complexity:
o Simple daily doses 42.35% to 47.76%
o Complex doses 57.65% to 52.24%
 Feasibility of enrollment in a text message
RCT was not related to:
o Age OR willingness to text
o Gender
o Multiple comorbid conditions
 Specialty Pharmacy recruitment:
o Reached a more diverse well educated
sample:
o >cell phone use
o >interest in RCT text messaging
 Compared to recruitment through cancer
clinics
PRACTICE IMPLICATIONS
 Novel recruitment strategies:
o Specialty Pharmacies:
 Reach different patients
 Broader population
 Text messaging interventions are used by
older adults in RCTs
 Text messaging may be usable in the clinical
setting; and in Specialty Pharmacies to
improve patient behaviors and outcomes
This research was funded by: McKesson Foundation Inc., Mobilizing for Health Grant Program, San Francisco, CA; & NCI R15 Grant Number 1R15CA176595