Title: A Text message Intervention to support MEdicines adherence mobiLised though community pharmacY (TIMELY)
Funder: Department of Health and Social Care

Abstract: Background It is known that around 40-60% of patients do not take their medicines as prescribed. Where patients do not take their medicines, the costs of unattained health gains has been estimated at 500million annually in England in five clinical scenarios alone (asthma, diabetes, schizophrenia, statins for the primary and secondary prevention of cardiovascular disease). The reasons for non-adherence are complex and there is a lack of evidence to support the different interventions which have been developed. However a recent Cochrane review highlighted the potential role of pharmacists and technology to support improved medicines adherence. The use of text messaging has been identified as being a useful tool in the healthcare setting and as being widely accessible for patients and also being cost-effective. This project aims to develop a text message based intervention to support medicines adherence. This intervention will be designed to respond to the challenges of multi-morbidity and polypharmacy, as well as investgating the mobilisation of a text message intervention through community pharmacies. Research question Is a text message intervention to support medicines adherence for patients with one or more long term conditions, delivered from a community pharmacy setting, acceptable to patients and feasible for study in a clinical trial? Aims Perform a narrative synthesis systematic review of the published and unpublished literature on the use of telehealth to support medicines adherence to inform the development of a new intervention Co-produce a text message based intervention package to support medicines adherence Develop a model of delivery for the text message based intervention package from a community pharmacy environment Conduct a feasibility study to inform the design of a RCT to test the model of a text message based intervention to support medicines adherence delivered from a community pharmacy environment Plan of investigation A narrative synthesis systematic review will be conducted to support the co-production of text message protocols and a delivery model from community pharmacies. The Florence system will be used which has been developed for use within the NHS. The review will incorporate both the published literature and unpublished evidence from the use of such technologies. The initial designs for the intervention and the delivery model will be refined using consensus methodologies. Nominal Group Technique will be used in focus groups containing key stakeholders and patients. There will also be an opportunity for more detailed feedback to be incorporated through further electronic communication following the focus groups. Finally, a feasibility study will be conducted using the newly designed intervention and delivery model. This will aim to inform the design of a future randomised controlled trial. Potential benefits to patients and the NHS This technology is already widely in use within the NHS, however work is mainly concentrated on specific therapeutic areas and not usually in primary care. The evidence for the use of such interventions, especially in relation to medicines adherence, is also lacking. This study aims to take an evidence-based approach to designing a new text message intervention that can meet the challenges of patients with multiple long-term conditions who are taking multiple medicines. It also looks at how these interventions can be made available more widely through using an existing service which already is providing medicines adherence support, community pharmacy. The feasibility study will aim to develop an evaluation framework that takes account of the complex nature of such an intervention and can also be used more widely by others wanting to evaluate the use of telehealth in their own settings. The aim is to take advantage of new technology to improve health, optimising the health gains from the NHS's investment in medicines.

Lay abstract: We know that around half of prescribed medications are not taken by patients as directed. We also know that if people do not take their medication, this can affect their health. The reasons why people do not take their medication are complicated. There are two main reasons, personal choice or difficulty taking them. Some people decide not to take their medication either because of what they believe about their health or what they think about their medication. Other people are prevented from taking their medication even if they want to because they have swallowing problems, get side effects from their medication, or they may have problems remembering to take them. There are many ways that we can help people take their medication, but one way that may help is using text messages. Text messages are currently being used to give information to patients about their health and long term conditions and also to collect information back from them. For example, text messages have been used to get blood pressure readings from patients. However text messages aren't being used a lot for these reasons because we don't know who will get the most benefit from receiving and sending back these messages. It also needs someone to set up the system and read the messages which are sent back from patients, and at the moment we don't know who this should be. Our research team want to find out if a text message system can be developed that can help lots of different people who might have one or more health problems. This might include messages to remind people to take their medication, messages to provide information about medication and health problems or messages to ask patients about side effects from their medication. We would also like to find out if pharmacists (chemists) might be able to introduce the text message system to people when they talk to them about their medication when they visit the pharmacy (chemist).This project is in four parts. The first part looks at how other researchers and healthcare services have already used technology to help people to take their medication. We will look at: the types of technology that have been used such as text messages, 'apps' or phone calls what information was given to patients about their medication what information patients sent back about their medication if technologies helped people to take their medication whether there was anything that made using these systems better or worse for patients whether patients liked using them or not The second part is using this prior work to start to build a new text message system to help people take their medication. We will show this system to patients, pharmacists and doctors in focus groups. Once we are happy with the text message system, in the third part we will look at how we can use it in real life in a pharmacy. We will look at what we found out from other researchers and health services and look at how we can make the text message system work. We will again show it to patients, pharmacists, doctors and people who buy services for the NHS using focus groups. This will aim to improve the ease of use of the system. The last step is to look at the ways in which the new text message system can be tested in a research study. This will help us make decisions about what a future research study will look like. This will include making sure that the text message system can be used by pharmacists and patients, and decide what we might ask patients to find out what they think about it. We also need to find out what we can measure to see if getting text messages helps people to take their medication and so improve their health. The study will also look at the impact of different factors that might affect how successful the text message system is for patients and professionals. We will have patients represented in this study by including them in a steering group that will oversee the project. This way, we aim to ensure that the views of people who might use the text message system are considered throughout the project. We hope that this project will help optimise the use of text message systems to help people take their medication, and we will also discover if we can test whether text messages do actually help people manage their medication in a research study.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS
Health categories: GENERIC HEALTH RELEVANCE