Respiratory-Medication Adherence Digital Health Solutions€¦ · Kiwi Kids Programme 23 November 2018 Maggie Scott, Head of Clinical Operations Adherium NZ Ltd, Auckland, New Zealand

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Respiratory-Medication AdherenceDigital Health Solutions Kiwi Kids Programme

23 November 2018

Maggie Scott, Head of Clinical Operations Adherium NZ Ltd, Auckland, New [email protected]

Respiratory Treatments

• Inhaled medications are the mainstay of treatment for chronic respiratory diseases

• Inhaled Corticosteroids (ICS) are the mainstay for chronic persistent asthma

• ICS are effective for the greater majority of patients with asthma

Private & Confidential © 2018 Adherium NZ Ltd

However… Poor Disease Control is Widespread

• 40% - 50% asthma patients exhibit poor control despite access to effective treatments


“The leading global issue in the management of asthma is adherence to inhaled corticosteroids”

- Professor Peter BarnesDM, DSc, FRCP, FCCP, FMedSci, FRSNZ Lung Day, May 2015


How Can We Measure Medication Adherence?

• Self Report?

• Electronic Monitoring Devices (EMDs)?

* New Zealand Health SurveyPrivate & Confidential © 2018 Adherium NZ Ltd

Measuring Medication Adherence: Self Report

Patel et al, MRINZ Wellington– Patient over-use under-

estimated and under-use over-estimated

– Conclusion: Self report is not reliable

Burgess et al, Mater, Brisbane– Patients, Care Givers, Health

Professionals each over estimated adherence

– No way of determining who was reliable and who wasn’t reliable

– Conclusion: Self report is not reliable


Measuring Medication Adherence: Electronic Monitoring Devices (EMD)

Adherium HailieTM

A range of electronic sensors that clip on to standard prescription inhalers


Measuring Medication Adherence: Electronic Monitoring Devices (EMD)

Conclusion: EMDs are accurate tools for objectively measuring patient medication adherence


Medication Adherence in Aotearoa Chan et al: Children & Teens 6 – 15, n = 110/220, Starship ED• Chan AH, Stewart AW, Harrison J, Camargo CA, Black PN, Mitchell EA: The effect of an

electronic monitoring device with audio-visual reminder function on adherence to inhaled corticosteroids and school attendance in children with asthma: A randomised controlled trial. The Lancet Respiratory Medicine 2015, 3(3): 210-19.

• Acute asthma• Emergency Department Attendance• On twice daily inhaled corticosteroid treatment• Measurement period 6 months• Electronic monitoring (Adherium Hailie)• Median Control Group ICS Adherence = 30%• Median Intervention Group ICS Adherence = 84%


Low ICS Medication Adherence isAssociated with Poor Outcomes

* Klok et al, ERJ 2014: Data collected using Adherium HailiePrivate & Confidential © 2018 Adherium NZ Ltd

Can Electronic Monitoring Devices (EMDs) Also Improve Medication Adherence?


Mini Meta-Analysis Assessing Impact of EMD(Track & Remind) on Medication Adherence

Study Year Mean SD Total Mean SD Total Weight IV, Random, 95% CI

Chan 2015 79 20 106 27 20 102 26.2% 52.00 (46.56, 57.44)

Charles 2007 88 16 44 66 27 46 26.2% 22.00 (12.88, 31.12)

Foster 2014 60 38 62 29 33 60 26.2% 31.00 (18.38, 43.62)

Morton 2016 70 20 39 49 20 38 26.2% 21.00 (12.06, 29.94

Total (95% CI)

74.3 251 42.8 246 100.0% 31.73 (13.91, 49.55)

Heterogeneity: Tau2 = 308.15; Chi2=52.34, df = 3 (P < 0.00001);12 = 94%Test for overall effect: Z = 3.49 (P = 0.0005)

Respiratory Drug Delivery Europe 2017 - Sutherland et al

Improvement in medication adherence due to EMD = 74%Private & Confidential © 2018 Adherium NZ Ltd

“The Smartinhaler could serve to improve interactions between people with asthma and their clinicians”

- National Institute for Health and Care Excellence: Smartinhaler for asthma. Medtech Innovation Briefing 90.

UK National Institute for Health and Care Excellence (NICE)


Adherium’s Hailie® Solution

Hailie Sensor Hailie App Hailie Cloud

Patient & Care Giver Health Professional


How Hailie™ Works

Patient clips Hailie Sensor on their prescription inhaler and uses as per normal.

1 Patient & Care-Giver can view medication use on the HailieTM App. Sensor reminders can be setup via the App.

2 Health Professional reviews inhaler usage on the HailieTM

App or Portal to discuss the best strategy for controlling the asthma in partnership with the Patient and their Caregiver

3


Hailie™ Setup in 3 Simple Steps

Sensors are compatible with a range of inhaler medications.

1 Receive the HailieTM sensor

Patients downloadthe App and Self-Enrollin the Programme

2 Download the HailieTM App

Patients can set reminders and start tracking medication usage

Start tracking inhaler usage

The HailieTM Sensor is paired to the App usingstep-by-step instructions

3 Pair via Bluetooth®

wireless


Private & Confidential © Adherium (NZ) Limited, 2016

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Objective Patient Medication Use from ADR Hailie8

Private & Confidential © Adherium (NZ) Limited, 2016

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Objective Patient Medication Use from ADR HailieⓇ9

Why Hailie™ for Kiwi Kids?

Reduction in Hospital Admissions for Children using the HailieTM

solution with missed dose reminders, over 12 months

Reduction in rescue medication use in children using the HailieTM

solution with missed dose reminders

Morton et al. (2016) Chan et al. (2015) Chan et al. (2015)


Hospitalisations

81%

Reliever Medication Use

46%

Reduction in emergency oral steroid use in children

using the HailieTM solution with missed dose reminders

Emergency Medication Use

37%

AotearoaCan we Change a Nation?


- Founded 2001, Auckland, by asthmatic

- Global Leader in connected smart inhalers

- More than 130,000 devices sold

- Monitored adherence > 200 Million hourslargest database in world

- Listed on Australian Stock Exchange, 2015

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Hailie Kiwi Kids Programme

Understanding Our AsthmaAdherium seeks for New Zealand to be the 1st country in the world to electronically map asthma medication usage and environmental data at a national level. Data generated will be anonymised and shared with Programme research teams to discover new insights into asthma prevalence, and potential new improvements in asthma management that can be provided to NZ children and shared with the international respiratory community.

Our App will capture Patient:• Medication dosage and time• Geographic location (anon)• Temperature to within 1ºC• Other environmental conditions

and Program Metrics:• # Centers• # Users enrolled• # Active users• # Sensors


Benefits

• To improve the lives of thousands of kiwi kids with asthma• A World 1st initiative• National Dataset & Insights• Adherium and its Sponsors are covering the costs• The potential to change practice following great results in New Zealand


Kiwi Kids Programme Site Participation

1 Introduction & Invitation to Participate

2 Agreement & Appointment of a Site Champion

Deployment with Patients, Re-supply, and Support

3 Initial Supply & Hands-on Training

4


How to Get Involved

• Talk to us

• Assign a Site Champion

• Do the on-line training, try it with a patient

* New Zealand Health SurveyPrivate & Confidential © 2018 Adherium NZ Ltd


Documents

Respiratory-Medication Adherence Digital Health Solutions€¦ · Kiwi Kids Programme 23 November 2018 Maggie Scott, Head of Clinical Operations Adherium NZ Ltd, Auckland, New Zealand