mHealth, Mexico, and HIV

I can tell I’m finally getting through my pile of interesting articles when I pick up an article from February 2010 in HealthAffairs, but it’s a good case study about Mexico’s use of cell phones and mobile technology.

The focus of the story is on VidaNET which is a cell-phone based system that sends text messages and e-mail to patients reminding them to take their medications, keep their physician’s appointments, and stay up to date on their lab tests.  The VidaNET program is for HIV patients and also provides them with other related health information.

“VidaNET is a technology platform that helps you self-manage your health.”

This solution is a partnership between the leading Mexican cellular company (Telcel) and the Carso Health Institute.  It built on their initial program called CardioNET which was focused on obesity related illnesses.  CardioNet featured a risk assessment tool that then drove the consumer to health related resources and provided them with facts to lead a healthier lifestyle.

Although a few of the statistics are now a year old, they are good on the access of the mobile channel:

  • 55% of the world’s citizens have mobile phones
  • It’s projected that by 2018 that there will be one cell phone per person in the world.
  • 80% of Mexicans own a cell phone and the country has more cell phones than people.
I also learned some interesting things about the Mexican healthcare system:
  • Patients don’t have access to their medical records (by law).
  • Doctors are often too busy to explain information to patients.
It clearly is a “physician as God” type of relationship where information is handed down for the patient to follow blindly.  That makes their use of telehealth even more radical by empowering the patient.
The article references two other studies on text messaging:
  • A Vodafone study that found that text messaging appointment reminders to patients in the UK reduced missed physician appointments by 33-50 percent.
  • A review of 14 studies in the American Journal of Preventative Medicine that found that text-messaging interventions produced positive behavior change in 93% of the cases.
I thought the article also did a good job of talking about why adherence is an issue for HIV patients and its importance:
  • Multiple doses of multiple drugs
  • Unpleasant side effects
  • Work only if drugs are taken at least 95% of the time
  • If patients go off their medications, it can lead to the growth of resistant strains of HIV
To some degree, the system is essentially sending you messages based on data you input which seems like a short-coming.  It’s not looking for refill data, planned appointments, and other information which might be electronically accessible.  You input data to set up your profile which then triggers reminders.
One of the cool features is a “stoplight” which tells you quickly your MPR (medication possession ratio).  If you miss your medications twice, you get a red light with the following:
“Don’t let the virus continue replicating.  LOOK FOR SUPPORT AND VISIT YOUR DOCTOR.”
At the time of the article, they were just working on DiabeDiario which is basically a Diabetes Diary.

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