Trial Review

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Trial registered on ANZCTR


Registration number
ACTRN12616001305415
Ethics application status
Approved
Date submitted
9/09/2016
Date registered
19/09/2016
Date last updated
19/09/2016
Type of registration
Retrospectively registered

Titles & IDs
Public title
MyMeds: A pilot study assessing the impact of technology in delivering personalised interventions to support patients to adhere to oral anti-diabetic medication
Scientific title
MyMeds: A pilot study assessing the impact of technology in delivering personalised interventions to support patients to adhere to oral anti-diabetic medication
Secondary ID [1] 290125 0
Nil Known
Universal Trial Number (UTN)
U1111-1187-1476
Trial acronym
Linked study record

Health condition
Health condition(s) or problem(s) studied:
Diabetes 300229 0
Condition category
Condition code
Metabolic and Endocrine 300105 300105 0 0
Diabetes

Intervention/exposure
Study type
Interventional
Description of intervention(s) / exposure
High Intervention: Receives support in adherence to oral diabetes medication via telemedicine. Participants fill in an initial screener assessing thier beliefs about medicines, and illness representations. This information guides the selection of interventional content. Personalised texts and emails are written by a health psychologist. Interventional content is aimed towards supporting and encouraging adherence to oral medications for diabetes.
This group receives personalised text messages, emails and access to a website with 7 pages of information about diabetes, and using diabetes medication . They will received daily text messages plus emails twice a week for weeks 1-6. Then text mesages 3 times a week and email once a week for weeks 7-26. This intervention group also receives five 15-20 minute interventional phone calls from a registered nurse as per the below schedule.
Day 1: Beliefs about Diabetes. Elicits discussion regarding illness representations for diabetes
Day 10: Concerns about Diabetes Medication. Elicits discsussion regarding concerns about costs, side effects, addiction to medication and other potential concerns about medication
Week 6: Elicits discussion and builds development of routines regarding organising and remembering
Week 9: Elicits discussion around medication necessity
Week 12: Elicits discussion around diabetes related distress.

Medium Intervention: Receives support in adherence to oral diabetes medication via telemedicine. Participants fill in an initial screener assessing thier beliefs about medicines, and illness representations. This information guides the selection of interventional content. Personalised texts and emails are written by a health psychologist. Interventional content is aimed towards supporting and encouraging adherence to oral medications for diabetes.
This group receives personalised text messages, emails and access to a website with 7 pages of information about diabetes, and using diabetes medication . They will receive daily text messages plus email twice a week for weeks 1-6. Then text mesages 3 times a week and email once a week for weeks 7-26. This intervention group also receives two 15-20 minute interventional phone calls from a registered nurse as per the below schedule.
Day 1: Beliefs about Diabetes. Elicits discussion regarding illness representations for diabetes
Day 10: Concerns about Diabetes Medication. Elicits discussion regarding concerns about costs, side effects, addiction to medication and other potential concerns about medication

Low Intervention: Receives support in adherence to oral diabetes medication via telemedicine. Participants fill in an initial screener assessing thier beliefs about medicines, and illness representations. This information guides the selection of interventional content. Personalised texts and emails are written by a health psychologist. Interventional content is aimed towards supporting and encouraging adherence to oral medications for diabetes..
This group receives personalised text messages, emails andaccess to a website with 7 pages of information about diabetes, and using diabetes medication. They will receive daily text messages plus email twice a week for weeks 1-6. Then text mesages 3 times a week and email once a week for weeks 7-26. This group does not receive any interventional phone calls from the nurse.

Examples of text messages: Participants receive text messages selected from a bank that are personally relevant to them according to thier initial screening questionnaire.

Diabetes is always with you. But it doesn’t need to get in the way of your life. You can look after yourself by taking your medication every day.
When taking your diabetes meds you may not feel any changes at all, especially if you felt fine before starting your medication. This is normal and common.

Examples of emails: Participants receive emails selected from a bank that are personally relevant to them according to thier initial screening questionnaire.
Example Email 1:If you find you are forgetting to take your medication, it’s a good idea to set up some systems to help you remember. Everyone is different, so what works for one person may not work for you. It may take a bit of practice before you find an approach that works for you. Read through the list below and think about whether any of these ideas might work for you.
a. Keep your medication in sight. That way when you see your medication, you will be reminded to take it.
b. Link taking your medication to something you do each day – like brushing your teeth or watching your favourite TV show.
c. Set up reminders. You could set up an alarm on your mobile phone or write it on the calendar.
d. You might find it helpful to carry some medicine with you each day. This will help you to take it when you need it.
Find out more here – [insert link to Don’t forget!]

Example email 2: Living with diabetes can feel overwhelming. You may have days when your diabetes makes you feel upset, worried or sad. It’s ok to feel this way. But don’t let these feelings get in the way of looking after yourself. Keep looking after yourself by taking your diabetes medication each day. In turn, you can feel better by knowing you are taking small steps to take control of your diabetes.
Find out more here – [insert link to It’s ok to feel sad or mad about having diabetes]
Intervention code [1] 295876 0
Behaviour
Intervention code [2] 295881 0
Treatment: Other
Intervention code [3] 295882 0
Treatment: Devices
Comparator / control treatment
Control: Non-randomised matched sample will serve as a control. This group will receive no intervention. The only data which will be extracted on this control group will be thier prescription redemption rates.
Control group
Active

Outcomes
Primary outcome [1] 299580 0
Adherence to oral diabetes medication measured by prescription redemption rate for oral diabetes medication.
Timepoint [1] 299580 0
This outcome will be assessed at 3, 6 and 12 months after the trial commences.
Secondary outcome [1] 327605 0
Self report non-intentional non-adherence to oral diabetes medication. Measured by the item
How often do you forget to take your diabetes medication?
Likert scale Never, Rarely, Sometimes, Often, Always.
Timepoint [1] 327605 0
This outcome will be assessed at 3, 6 and 12 months after the trial commences.
Secondary outcome [2] 327606 0
Self report intentional non-adherence to diabtetes medication measured by: How often do you choose not to take your diabtetes medication. Likert scale Never, Rarely, Sometimes, Often, Always.
Timepoint [2] 327606 0
This outcome will be assessed at 3, 6 and 12 months after the trial commences.

Eligibility
Key inclusion criteria
Participants will be eligible to participate in this study if they have Type 2 diabetes for which they are prescribed oral medications only and are over 18. Participants who are prescribed insulin will be excluded from this study. Participants will be included in the study only if they have daily access to a mobile phone.
Minimum age
18 Years
Maximum age
No limit
Sex
Both males and females
Can healthy volunteers participate?
No
Key exclusion criteria
Cannot read English. No Access to a mobile phone.

Study design
Purpose of the study
Educational / counselling / training
Allocation to intervention
Randomised controlled trial
Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Allocation is not concealed.
Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Simple randomisation using a randomised table created by computer software.
Masking / blinding
Open (masking not used)
Who is / are masked / blinded?



Intervention assignment
Parallel
Other design features
Phase
Not Applicable
Type of endpoint/s
Efficacy
Statistical methods / analysis
Power Calculation
To estimate an adequate sample size, a power calculation was conducted. The effect size was based on data from two research papers exploring adherence in diabetes. Vervloet and collegues (2012) demonstrated that mean adherence (measured with electronic monitoring device) was 10.3% higher in the group receiving text reminders and those in the control group. The standard deviation of prescription redemption data was likely to be higher than that of the electronic monitoring device data, therefore the standard deviation of the sample was estimated from Wilke et al (2016). In this study Medications Prescription redemption data was used to calculate adherence to diabetes medications across a range of international research sites revealing an average standard deviation of 29.9%. Using a significant level of p<.05 with a two tailed test and an 80% probability of detecting an effect, these figures give an effect size of 0.34 and a final sample size required per group of 134. Once we include the attrition rate of 30% that gives a sample size required per group of 171 and a total sample of 1026 for the three intervention groups and the matched sample which will form the control group.
Data analysis
Data will be analysed using SPSS. Data will be collated on an intention to treat basis. Data will be cleaned according to best practice principles, as follows. Data will be entered into an SPSS data file and then subjected to a cleaning procedure to identify mis-entered variables. This involves scanning frequency tables and removing mis-entered data.
Missing data will be accounted for using two procedures reported by Byrne (2001), list wise deletion and pattern matching imputation.
Participants with missing data (and those who withdraw during the course of the study) will be compared with the final sample to assess if they differ significantly on any demographic or baselines measures. These results will be reported.
Data will be checked for normality. A mixed between and within ANOVA (or its non-parametric equivalent) will be used to explore the hypotheses, comparing change in adherence levels between groups. This will account for any differences present between groups at baseline.

Recruitment
Recruitment status
Recruiting
Date of first participant enrolment
Anticipated
Actual
10/03/2016
Date of last participant enrolment
Anticipated
30/11/2016
Actual
Date of last data collection
Anticipated
30/11/2017
Actual
Sample size
Target
1026
Accrual to date
Final
Recruitment outside Australia
Country [1] 8222 0
New Zealand
State/province [1] 8222 0

Funding & Sponsors
Funding source category [1] 294498 0
Government body
Name [1] 294498 0
PHARMAC
Country [1] 294498 0
New Zealand
Primary sponsor type
Commercial sector/Industry
Name
Atlantis Healthcare
Address
PO Box 37012
Parnell
Auckland 1151
Country
New Zealand
Secondary sponsor category [1] 293362 0
None
Name [1] 293362 0
Address [1] 293362 0
Country [1] 293362 0

Ethics approval
Ethics application status
Approved
Ethics committee name [1] 295931 0
Northern A Health and Disability Ethics Commitee
Ethics committee address [1] 295931 0
PO BOx 5013
Wellington
6011
Ethics committee country [1] 295931 0
New Zealand
Date submitted for ethics approval [1] 295931 0
30/06/2016
Approval date [1] 295931 0
25/08/2016
Ethics approval number [1] 295931 0
16/NTA/99

Summary
Brief summary
Adherence to oral medication in Type 2 Diabetes is suboptimal. Patients reasons for non-adherence are multiple, and have been consistently demonstrated to be associated with patients’ beliefs about their illness and treatment (e.g., Horne et al., 2005). Patient beliefs about their illness and treatment are amenable to intervention (e.g., Clifford et al., 2006; Petrie et al., 2002; Petrie et al., 2012) and increasingly we are seeing the use of technology (e.g., SMS, internet, nurse-delivered tele-health) as a means of delivering healthcare interventions. The results from this study will allow us to determine whether technology can be used to improve medication adherence to oral medication for people living with Type 2 Diabetes in New Zealand. PHARMAC and the Ministry of Health will use the results of this study to guide policy.
There are two key hypotheses in this study. 1. That people assigned to an intervention arm will achieve significantly greater medication adherence levels than control patients. 2. That people assigned to receive the most intensive level of intervention (e.g., SMS and web programme plus 5 phone calls) will achieve significantly greater medication adherence levels than patents assigned to lesser levels of intervention (e.g., SMS and web programme only, and SMS and web programme plus two phone calls).

Five hundred and thirteen people prescribed oral medication for diabetes will be recruited from GP practices around New Zealand. They will be randomly allocated to three groups: low intervention, medium intervention and high intervention. The intervention will last six months, with a 12 month follow up. Participants will complete a questionnaire at baseline about their illness and treatment beliefs and this will be used to personalise the content they receive. Participants in all the groups receive personalised interventional text messages, emails and access to a website with diabetes specific information. Medium and high intervention streams receive interventional nurse phone calls at different frequencies.
Data will be collected through self-report, and through mining of a public database of de-identified prescription redemption data. Participants will be invited to complete screening questions by telephone 3, 6 months, and 12 months after enrolling in the study. Prescription redemption data will be accessed for all enrolled participants 12 months after they enrol in the study. This data will assess their medication possession rates for the six months prior to intervention, and the 12 months following their enrolment. At this point a matched sample of 513 people will be identified to serve as a control. This de-identified data will be accessed from NZePS by the Ministry of Health and sent to PHARMAC. PHARMAC will compare the medications possession ratio data from the intervention study participants with the matched sample.
Trial website
Trial related presentations / publications
Public notes
Reasons for delay in completing formal ethics approval for the study.
Both Atlantis Healthcare and PHARMAC (study sponsor) were unclear at the outset of study design whether formal ethics committee approval was necessary for the study. Part-way through the enrolment process we re-visited this issue and decided that it was necessary to acquire formal approval. This was done, with enrolment into the study being paused until full approval was received from the Health and Disability Ethics Committee (HDEC). In hindsight we acknowledge that we should have acquired ethics committee approval during the study design phase, before implementation began.

HDEC approved a process to allow patients who were already enrolled in the study the opportunity to give their informed consent to the study and continue following ethics committee approval. Patients were given three options:

To consent to continue to receive interventional content AND remain as part of the study group; OR
To consent to continue to receive interventional content but not remain as part of the study group: OR
Decline receiving further interventional content AND decline to be part of the study group.

Our study nurses contacted patients to outline the situation re ethics approval and offer the above options. All but one of the contacted participants have decided to consent to continue on the programme and the study, Only one person has declined to be part of the study, but wanted to continue to receive the interventional content. This patient has now been removed from the study sample.

Contacts
Principal investigator
Name 68942 0
Dr Jodie Main
Address 68942 0
Atlantis Healthcare, PO Box 37012, Parnell, Auckland 1151,
Country 68942 0
New Zealand
Phone 68942 0
+64274034785
Fax 68942 0
Email 68942 0
[email protected]
Contact person for public queries
Name 68943 0
Mr Andrew Beszant
Address 68943 0
Atlantis Healthcare, PO Box 37012, Parnell, Auckland 1151,
Country 68943 0
New Zealand
Phone 68943 0
+64212753555
Fax 68943 0
Email 68943 0
[email protected]
Contact person for scientific queries
Name 68944 0
Dr Jodie Main
Address 68944 0
Atlantis Healthcare, PO Box 37012, Parnell, Auckland 1151,
Country 68944 0
New Zealand
Phone 68944 0
+64274034785
Fax 68944 0
Email 68944 0
[email protected]

No information has been provided regarding IPD availability


What supporting documents are/will be available?

No Supporting Document Provided



Results publications and other study-related documents

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No documents have been uploaded by study researchers.

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