http://www.mycare4life.com/

Care4life background | Type II diabetes

Goal 1Increase medication adherence through reminders and education

Goal 2Increase exercise and reduce

weight through goal tracking and motivations

Goal 4Increased appointment attendance through education and reminders

Goal 3Improved blood glucose control

(reduced A1c) through monitoring and education

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Care4life user experience | Key service components

AADE7 self-care behaviors (motivation)

NDEP Modular program (education)

Education/ Motivation

Patient Record

Care4Life. Reminder: Your doctor’s appointment (Dr. Johnson @ 9am) is tomorrow. Jot down any questions you have. Reply APPOINTMENT to set a new reminder.

Reminders

Monitoring/ feedback

Care4Life. Time to check your BEFORE meal glucose. Reply with your BEFORE meal glucose reading (e.g. 125).

6 MONTH PROGRAMBi-lingualSelf/ provider enrollmentText data collectionHighly interactive

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Objective 1 | Increase Medication Adherence

– System sends education tips on medication and adherence

– User programmed medication reminders (with tips)

– System asks weekly medication adherence survey & provides immediate feedback

– User can track progress on web portal

Care4Life. 7am med reminder: Sometimes you might feel overwhelmed. Remember to take it one day at a time. Focus on what you can do today.

Medication reminder Adherence survey Survey Feedback

Care4Life. Even if you feel good, do not stop taking your diabetes medications. Talk to your doctor before changing your diet, exercise plan, or medications.

Education

Care4Life. Did you remember to take all your drugs last week? Reply 1 for took all, 2 for took most, 3 for took some, 4 for took none (e.g. Reply 2)

Care4Life. Fantastic! Taking all of your drugs on time will really help you stay healthy. Reply MYGOALS to set or update your weight or exercise goals

Care4Life. Try to exercise at least 5 days each week unless your doc has told you not to. Reply with the number of days you will exercise this week (e.g. 7)

Set exercise goal Exercise survey Survey Feedback

Care4Life. How does physical activity help manage blood glucose? When we exercise, sugar in our blood moves to cells where they are used as energy.

Education

Care4Life. Did you meet your goal of exercising at least 3 days last week? Reply with the number of days you exercised last week (e.g. Reply 3)

Care4Life. OK so you missed your exercise goal of 3 days last week. Don't give up. Regular exercise is one of the best ways of improving your health

Objective 2 | Increase Physical Activity

• System sends education messages & tips on physical activity

• User programmed exercise goal

• System asks weekly goal progress and provides immediate feedback

• User can track progress on web portal

• User enters weight & height at enrollment; System generates suggested healthy weight range (based on BMI)

• User sets target weight goal at enrollment

• System sends weekly survey & sends immediate feedback

• User can track progress on web portal

• System sends education messages & tips

Care4Life. It's time for your weekly check-in. The target you set for your weight is 185 pounds? Reply with your current weight in pounds (e.g. Reply 180).

Care4Life. You are just 5 pounds from your weight goal of 185 pounds. Plan out your exercise and meals for next week. You are nearly there!

Weight loss progress graph on web portal

Weekly weight loss progress survey System feedback

Objective 3 | Increase Weight Loss

• System sends education messages & tips about maintenance of health blood glucose levels

• System sends SMBG reminders according to doctor’s recommendations about timing (e.g. before breakfast)

• User enters A SAMPLE of SMBG readings and receives feedback relative to standard goals

• User can track all glucose recordings on web portal

Care4Life. Reminder: Test your BEFORE meal blood glucose. Reply with your test result (eg. 120).

Test reminder Feedback Web Record

Care4Life. With clean hands, use the lancet device to poke the fleshy side of the fingertip, slightly off center from the middle of the tip (hurts less).

Education

Care4Life. A before meal glucose result of 70 or less can be dangerous. Do you know what low sugar feels like? Do you know what to do? Text LOW to learn more.

Objective 4 | Increase Blood Glucose Control

• System sends education messages & tips about maintenance of healthy blood pressure

• System sends reminders to test and record blood pressure

• User enters blood pressure readings and receives feedback relative to standard goals

• User can track all blood pressure recordings on web portal

Care4Life. Test your blood pressure. Make sure to sit still and do not talk. Then reply with your blood pressure numbers separated by a space (e.g. 145 90).

Test reminder Feedback Web Record

Care4Life. For most people with diabetes, recommended blood pressure target is 130/80 mmHg or lower. Ask your care team what your target blood pressure is.

Education

Care4Life. Blood pressure readings of 130/80 or less can help you stay healthy. Exercise most days of the week to keep your blood pressure under control.

Objective 5 | Improve Blood Pressure Control

• User can set up appointment reminders

• System sends appointment reminders before and day of appointment

• System sends education messages & tips

• User can track upcoming appointments on web portal

Care4Life. Before you travel, ask your doctor for travel tips. Be sure to pack extra medications and diabetes supplies in case of an emergency.

Care4Life. This is a reminder that your doctor's appointment is today. Don't be afraid to ask questions. Reply APPOINTMENT to set a new reminder.

Education messageAppointment reminder System feedback

Care4Life. Reminder: Your doctor’s appointment (Dr. Johnson @ 9am) is tomorrow. Jot down any questions you have. Reply APPOINTMENT to set a new reminder.

Objective 6 | Increase Appointment Attendance

Care4Life. Reminder: Test your AFTER meal blood glucose. Reply with your test result (e.g. 120).

188

Care4Life. After meal glucose results of 181 to 250 are above the ideal range. Text HIGH for more info and tell your doctor about high readings.

Integration | SMS & Web Integration

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Personal Portal

Manage Subscriptions

Exercise Progress

Weight Loss Progress

Medication Adherence

Glucose Readings

Medication Reminders

Appointment Reminders 11

Data | On-line and real-time

Goal trackingSMBG and BP Monitoring

User’s personal profile

Data can be identified and de-identified for providers and researchers and includes:

Interactions with the service

Glucose and blood pressure reports

Weight, exercise and adherence

progress

Enrollment and participant status

information

User interactions

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Message Dosage M T W T F S S

Coaching/Motivation 8a 8a 8a

Education 6p 6p

Medicine Reminder* 3p 3p 3p 3p 3p 3p 3p

Blood Glucose Reminder* 7:30a 10a 11:30a 2pm 6:30p 9p

Blood Pressure Reminder* 2p

Weekly Goals Survey* 10a 6p

Total Messages 3 4 3 3 3 3 2

Care4Life. Sometimes blood glucose can drop too low. You may feel shaky, sweaty or dizzy. If you have symptoms, test glucose right away. Text LOW for more info.

Care4Life. Hi, it's Paula. Make a date to exercise. Call a friend to take a walk. Go dancing. Come up with new ideas to get active. It's good for both of you!

Care4Life. This is your 3pm med reminder. Tip: Make a list of the foods you need for the week. Stick to your list. You'll eat healthier and save money, too.

Education Message Coaching/Motivation Medicine Reminder

Care4Life Messages | Content and Dosage

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Care4Life | Patient-centric program

User can turn on/off various components Glucose monitoring, medication reminders, weight and exercise tracking, blood pressure reminders

User can use system entirely via SMS or combination of SMS/web User sets time of waking up and time of meals User sets number and timing of medicine reminders

User can turn on/off various components Glucose monitoring, medication reminders, weight and exercise tracking, blood pressure reminders

User can use system entirely via SMS or combination of SMS/web User sets time of waking up and time of meals User sets number and timing of medicine reminders

PersonalizedPersonalized

Support pal checks in with users in the morning and provides helpful motivation and tips “Quiz” at the end of each lesson to engage user and reinforce educational content Prompts to record readings and progress against weight and exercise goals Tailored feedback based on inputs Keywords for user to get more information or record readings

Support pal checks in with users in the morning and provides helpful motivation and tips “Quiz” at the end of each lesson to engage user and reinforce educational content Prompts to record readings and progress against weight and exercise goals Tailored feedback based on inputs Keywords for user to get more information or record readings

Interactive & EngagingInteractive & Engaging

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Evidence | Text-based programs improve A1c

Multiple randomized controlled trials have showed significant reductions in HbA1c levels1,2, increases in medication

adherence and increases in glucose monitoring2 as a consequence of text based interventions. Text-based medication and monitoring reminders have been shown to be effective and increase adherence in a wide

variety of patients with chronic conditions including diabetes.2

Evaluations underway of care4life show users’ participation, retention and active engagement.

Multiple randomized controlled trials have showed significant reductions in HbA1c levels1,2, increases in medication

adherence and increases in glucose monitoring2 as a consequence of text based interventions. Text-based medication and monitoring reminders have been shown to be effective and increase adherence in a wide

variety of patients with chronic conditions including diabetes.2

Evaluations underway of care4life show users’ participation, retention and active engagement.

Strong evidence basis that mobile interventions workStrong evidence basis that mobile interventions work

Sources: 1. Cho. 2009.2. Yoon. 2008.

3. Krishna and Boren. 2008.4. System data. Based on users enrolled avg of 124 days; status as of 2/20/2012.

“Our patients find Care4life very useful. It reinforces our key messages and is helping them make positive changes.”

Diabetes EducatorSan Diego

# of Education Messages

# of Medication Reminders

# of Glucose Reminders

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