Mobile telephone contingency management to encourage adherence to supervised medication among individuals most at risk of non-adherence to opioid agonist treatment: a study protocol for a feasibility study (TIES2).

IF 1.6 Q3 MEDICINE, RESEARCH & EXPERIMENTAL
Nicola Metrebian, Carol-Ann Getty, Ewan Carr, Timothy Weaver, Stephen Pilling, Mike Kelleher, Jenny Scott, John Strang
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引用次数: 0

Abstract

Background: Supervision of opioid agonist treatment (OAT) ensures that individuals take their correct daily dose to minimise withdrawal and craving, safeguard against diversion and overdose, and receive optimal benefit from OAT. There is an urgent need to develop effective interventions to increase medication adherence and technological solutions to streamline communication between pharmacies and prescribers. The authors have developed technology to deliver contingency management (CM) remotely by mobile telephone (mCM) and alert prescribers of missed doses. In a previous feasibility study, the authors found mCM was feasible to deliver and acceptable to patients, prescribers, and pharmacists but encountered difficulty recruiting patients starting methadone treatment. Since COVID-19, supervision guidelines have changed to focus on patients at risk of/not adhering to their medication. This study aims to assess the feasibility of conducting a future confirmatory trial to assess the clinical and cost-effectiveness of mCM to encourage adherence with supervised methadone or buprenorphine. It will use broader eligibility criteria, including patients receiving buprenorphine, and target a revised group of serial re-starters.

Methods: Using a cluster randomised design, three drug services will be randomised 1:1:1 and 20 patients, attending seven pharmacies linked to each service, will be recruited (i.e. a total of N = 60). Each drug service providing supervised medication will be randomly allocated to deliver: (i) telephone-delivered text-message reinforcement with modest financial incentives; (ii) telephone-delivered text-message reminders; or (iii) no telephone text-messages. Prescribers will receive reports of patient attendance. Feasibility will be determined based on four progression criteria: the number of patients enrolled, the percentage of screened patients who are eligible, adherence to the telephone system, based on matches between sign-in at the pharmacy and pharmacy dispensing records and follow-up rates. We will also undertake qualitative assessments of clinicians' perspectives on the revised eligibility criteria undertaken.

Discussion: This study will assess the feasibility of using mCM to target a clinically important group of patients non-adhering to their supervised medication. In the future, and if effective, mCM will encourage medication adherence among patients, enabling them to achieve an optimum dose and full benefit from OAT.

Trial registration: ISRCTN33965312 (26/06/2023). This manuscript was submitted on February 27th, 2024. While recruitment was due to end on February 29th, we recruited our last patient on February 12th. The last patient/last visit took place on May 2nd, 2024.

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移动电话应急管理,鼓励最有可能不坚持阿片类激动剂治疗的个人遵守监督药物治疗:可行性研究的研究方案(TIES2)。
背景:监督阿片类激动剂治疗(OAT)确保个人服用正确的每日剂量,以尽量减少戒断和渴望,防止转移和过量,并从OAT获得最佳效益。迫切需要制定有效的干预措施,以提高服药依从性,并制定技术解决方案,以简化药房和开处方者之间的沟通。这组作者开发了一种技术,通过移动电话远程提供应急管理(CM),并提醒处方者错过的剂量。在之前的可行性研究中,作者发现mCM对患者、处方医生和药剂师来说是可行的,并且可以接受,但在招募开始美沙酮治疗的患者方面遇到了困难。自2019冠状病毒病以来,监管指南已经改变,重点关注有风险/不坚持服药的患者。本研究旨在评估开展一项未来验证性试验的可行性,以评估mCM的临床和成本效益,以鼓励患者坚持服用有监督的美沙酮或丁丙诺啡。它将使用更广泛的资格标准,包括接受丁丙诺啡的患者,并针对一组经过修订的连续重新启动者。方法:采用整群随机设计,将三个药物服务按1:1:1随机分配,并招募20名患者,分别在与每个服务相关的7家药房就诊(即总共N = 60)。每个提供监督用药的药物服务机构将被随机分配,以提供:(i)通过电话发送的短信加强,并提供适度的财政奖励;(ii)电话发送短信提醒;或者(iii)禁止电话短信。开处方者将收到病人的出勤报告。可行性将根据四个进展标准来确定:登记的患者数量、筛选的符合条件的患者百分比、对电话系统的依从性、基于药房签到和药房配药记录之间的匹配以及随访率。我们还将对临床医生对修订后的资格标准的看法进行定性评估。讨论:本研究将评估使用mCM的可行性,以临床重要的患者群体为目标,不坚持他们的监督药物。在未来,如果有效,mCM将鼓励患者的药物依从性,使他们能够获得最佳剂量并从OAT中充分受益。试验注册:ISRCTN33965312(26/06/2023)。本文于2024年2月27日提交。虽然招募将于2月29日结束,但我们在2月12日招募了最后一位患者。最后一位患者/最后一次就诊发生在2024年5月2日。
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来源期刊
Pilot and Feasibility Studies
Pilot and Feasibility Studies Medicine-Medicine (miscellaneous)
CiteScore
2.70
自引率
5.90%
发文量
241
审稿时长
9 weeks
期刊介绍: Pilot and Feasibility Studies encompasses all aspects of the design, conduct and reporting of pilot and feasibility studies in biomedicine. The journal publishes research articles that are intended to directly influence future clinical trials or large scale observational studies, as well as protocols, commentaries and methodology articles. The journal also ensures that the results of all well-conducted, peer-reviewed, pilot and feasibility studies are published, regardless of outcome or significance of findings. Pilot and feasibility studies are increasingly conducted prior to a full randomized controlled trial. However, these studies often lack clear objectives, many remain unpublished, and there is confusion over the meanings of the words “pilot” and “feasibility”. Pilot and Feasibility Studies provides a forum for discussion around this key aspect of the scientific process, and seeks to ensure that these studies are published, so as to complete the publication thread for clinical research.
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