JMIR Publications

ABSTRACT

Background:

Patients with inflammatory rheumatic diseases often experience drug-related problems (DRPs). As these can result in negative health consequences, DRPs should be identified and solved in a timely manner. Text messaging between patients and pharmacists at the initiative of the patient has the potential to deliver support with DRPs more continuously, increase accessibility and efficiency, and enhance patient-involvement in the process of identifying and solving DRPs.

Objective:

Before large-scale implementation however, assessing the feasibility of text messaging from both the patients’ and healthcare practitioners’ perspective is necessary.

Methods:

Adult patients using a disease-modifying anti-rheumatic drug were given access to text messaging with pharmacists to discuss drug-related problems for a period of eight weeks. Patients received a response by a pharmacist within four working-hours. Feasibility was evaluated based on five domains of Bowen’s framework for designing feasibility studies: 1) Demand: Actual use, expressed interest (User version of the Mobile Application Rating Scale – section E), factors impacting future use; 2) Limited-efficacy: number of DRPs solved, DRPs resulting in follow-up, DRPs warranting involvement of healthcare provider; 3) Implementation: degree of execution (number of conversations answered within service-level) and resources needed (pharmacists’ time investment per conversation); 4) Acceptability: satisfaction and appropriateness (Theoretical Framework Acceptability); 5) Practicality: ability to carry out intervention activities (System Usability Scale). Data were collected by means of usage data and a questionnaire.

Results:

Forty-five patients (median (IQR) age 57 (52-65) years, 70% female) and five pharmacists (median (IQR) 41 (26-47) age years, 20% female) actively participated in this study. 1) Demand: 158 unique DRPs were raised in 133 conversations, with a median (IQR) of 3 (2-4) unique DRPs per patient. Expressed interest was rated high by patients (median (IQR) 4 (4-5)) and 95% of patients would recommend text messaging to others; 2) Limited-efficacy: all DRPs were solved and 77% of DRPs warranted involvement of a healthcare provider; 3) Implementation: 87% of conversations were answered within the promised timeframe with a median (IQR) time investment of 4:15 (2:21 – 7:27) minutes per conversation; 4) Acceptability was rated high by patients (median (IQR) 4 (4-5)) and pharmacists (median (IQR) 5 (4-5)); 5) Practicality: System Usability Scale was scored above average for patients (mean (SD) 72 (18)) and pharmacists (mean (SD) 81 (16)).

Conclusions:

Text messaging with pharmacists at the initiative of patients with rheumatic diseases seems feasible for discussing drug-related problems in terms of limited-efficacy, implementation, acceptability, demand, and practicality for patients and pharmacists.