Metrebian N, Carr E, Goldsmith K, Weaver T, Pilling S, Shearer J, Woolston-Thomas K, Tas B, Cooper C, Getty C A, van der Waal R, Kelleher M, Finch E, Bijral P, Taylor D, Scott J, Strang J
King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AB, UK.
Department of Mental Health, Social Work and Integrative Medicine, School of Health and Education, Middlesex University, London, NW4 4BT, UK.
Pilot Feasibility Stud. 2021 Jan 7;7(1):14. doi: 10.1186/s40814-020-00761-4.
Prescription methadone or buprenorphine enables people with opioid use disorder to stop heroin use safely while avoiding withdrawal. To ensure methadone is taken as prescribed and to prevent diversion onto the illicit market, people starting methadone take their daily dose under a pharmacist's supervision. Many patients miss their daily methadone dose risking withdrawal, craving for heroin and overdose due to loss of heroin tolerance. Contingency management (CM) can improve medication adherence, but remote delivery using technology may be resource-light and cost-effective. We developed an innovative way to deliver CM by mobile telephone. Software monitors patients' attendance and supervised methadone consumption through an internet self-login at the pharmacy and sends reinforcing text messages to patients' mobile telephones. A linked system sends medication adherence reports to prescribers and provides early warning alerts of missed doses. A pre-paid debit card system provides financial incentives.
A cluster randomised controlled trial design was used to test the feasibility of conducting a future trial of mobile telephone CM to encourage adherence to supervised methadone in community pharmacies. Each cluster (drug service/3 allied pharmacies) was randomly allocated to provide patient's presenting for a new episode of opiate agonist treatment (OAT) with either (a) mobile telephone text message CM, (b) mobile telephone text message reminders, or (c) no text messages. We assessed acceptability of the interventions, recruitment, and follow-up procedures.
Four drug clinics were approached and three recruited. Thirty-three pharmacists were approached and 9 recruited. Over 3 months, 173 individuals were screened and 10 enrolled. Few patients presented for OAT and high numbers were excluded due to receiving buprenorphine or not attending participating pharmacies. There was 96% consistency in recording medication adherence by self-login vs. pharmacy records. In focus groups, CM participants were positive about using self-login, the text messages, and debit card. Prescribers found weekly reporting, time saving, and allowed closer monitoring of patients. Pharmacists reported that the tablet device was easy to host.
Mobile telephone CM worked well, but a planned future trial will use modified eligibility criteria (existing OAT patients who regularly miss their methadone/buprenorphine doses) and increase the number of participating pharmacies.
The trial is retrospectively registered, ISRCTN 58958179 .
开具美沙酮或丁丙诺啡处方可使患有阿片类药物使用障碍的人安全地停止使用海洛因，同时避免戒断反应。为确保美沙酮按规定服用并防止其流入非法市场，开始服用美沙酮的人在药剂师的监督下服用每日剂量。许多患者会错过每日美沙酮剂量，从而面临戒断反应、渴望海洛因以及因失去海洛因耐受性而导致过量用药的风险。应急管理（CM）可以提高药物依从性，但使用技术进行远程交付可能资源消耗少且具有成本效益。我们开发了一种通过移动电话提供CM的创新方法。软件通过药房的互联网自助登录来监测患者的就诊情况和监督下的美沙酮服用情况，并向患者的移动电话发送强化短信。一个关联系统会将药物依从性报告发送给开处方的医生，并提供漏服剂量的早期预警警报。一个预付费借记卡系统提供经济激励。
采用整群随机对照试验设计来测试未来进行一项关于移动电话CM以鼓励社区药房患者坚持接受监督下美沙酮治疗的试验的可行性。每个整群（药物服务/3家联合药房）被随机分配，为新开始阿片类激动剂治疗（OAT）的患者提供以下服务之一：（a）移动电话短信CM，（b）移动电话短信提醒，或（c）不发送短信。我们评估了干预措施、招募和随访程序的可接受性。
联系了4家药物诊所，招募了3家。联系了33名药剂师，招募了9名。在3个月的时间里，筛选了173人，10人入选。很少有患者前来接受OAT，并且由于接受丁丙诺啡或未前往参与的药房而有大量患者被排除。通过自助登录与药房记录记录药物依从性的一致性为96%。在焦点小组中，CM参与者对使用自助登录、短信和借记卡持积极态度。开处方的医生发现每周报告节省时间，并且能够更密切地监测患者。药剂师报告说平板电脑设备易于托管。
移动电话CM效果良好，但计划中的未来试验将使用修改后的入选标准（经常错过美沙酮/丁丙诺啡剂量的现有OAT患者）并增加参与药房的数量。
该试验为回顾性注册，ISRCTN 58958179 。
