Research output: Contribution to journal › Article › peer-review
Nicola Metrebian, Ewan Carr, Kimberley Goldsmith, Timothy Weaver, Stephen Pilling, James Shearer, Kathryn Woolston-Thomas, Basak Tas, Charlotte Cooper, Carol-Ann Getty, Rob van der Waal, Michael Kelleher, Emily Finch, Prun Bijral, David Taylor, Jenny Scott, John Strang
Original language | English |
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Article number | 14 |
Pages (from-to) | 1-12 |
Number of pages | 12 |
Journal | Pilot and Feasibility Studies |
Volume | 7 |
Issue number | 1 |
DOIs | |
Accepted/In press | 14 Dec 2020 |
Published | 7 Jan 2021 |
Additional links |
TIES Feasibility Metrebian Revised 18.10.20 Updated 16.12.2020
TIES_Feasibility_Metrebian_Revised_18.10.20_Updated_16.12.2020.docx, 73.5 KB, application/vnd.openxmlformats-officedocument.wordprocessingml.document
Uploaded date:16 Dec 2020
Version:Accepted author manuscript
Metrebian_et_al-2021-Pilot_and_Feasibility_Studies
Metrebian_et_al_2021_Pilot_and_Feasibility_Studies.pdf, 816 KB, application/pdf
Uploaded date:08 Jan 2021
Version:Final published version
Background: 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. Methods: 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. Results: 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. Conclusion: 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. Trial registration: The trial is retrospectively registered, ISRCTN 58958179.
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