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Epilepsy: Flo’s simplicity improves medication compliance

posted 12 Jun 2018, 01:48 by Hollie O'Connell

The Shrewsbury and Telford Hospital  
NHS Trust 
Conor Smyth
Specialist Epilepsy Nurse 


15 June 2018 



Conor Smyth is a Specialist Epilepsy Nurse at The Shrewsbury and Telford Hospital, he works within the neurology team to provide care, advice and support to his patients with epilepsy.  Conor has recruited Flo to help his patients for a number of years now, and he recently took some time to share his experiences of using Flo.



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Getting Started

My journey with Flo started around 5 years ago when I met with Lisa and we discussed how Flo could help patients in my cohort to develop better medication habits, and reduce the likelihood of the avoidable side effects on non-adherence to their regime.  I introduced Flo to prompt patients at agreed times to take their medication, and the use has been sustained across the cohort.  I haven’t used Flo’s other features yet, e.g. recording number of seizures, as I like the simplicity and impact of the reminder messages.  I think that it’s the simplicity that has appealed to a lot of my patients as well, as when I discussed Flo helping them to remember to take their medication they seemed quite keen to take it up.

Currently I have a caseload of around 35 patients; most are under 30 years old, including a significant proportion of teenage patients. It can be difficult at any age to get into a routine of taking medication, and sometimes more challenging in the teenage age group.  We do see the effect of challenges around medication compliance, especially amongst the younger patients.   For some, there are additional cognitive issues that can be associated with their epilepsy, so ensuring that they take their medication as prescribed can be tricky.

What we did before Flo

Before using Flo, we would talk patients through practical ways to remind themselves to take their medication in clinic, for example using dosset boxes that would clearly show whether they’d taken their medication or not.   Another common tip would be to suggest that they put their medication in places that are part of their daily routine, for example by the kettle so it’s there in the morning when they make their first cup of tea.  We do find that a lot of people have family members around to remind them, so a lot of the time they were having to do the prompting; this can put pressure and strain on family members or any other carers the patient may have. 

How do we use Flo and how does Flo help patients?


Now Flo helps my patients to take their medication on time; the frequency of Flo’s prompts varies dependent on the patient’s dosage, but it’s normally twice a day.  What I’ve seen is that Flo can really help to promote more independence and better self-management.  This then helps to take some of the responsibility away from family members or carers.  We find this is particularly helpful for our teenage patients. 

Parents usually take on the responsibility of reminding them to take their medication, and then often worry that they’ve created a dependence as they won’t be there to prompt them in a few years when they go to university or move out.  Knowing that Flo is there to help provides consistency and takes the onus off parents, and reassures them that it’s a way going forward for their children to become more independent and still manage their epilepsy.



When I introduce patients to Flo, I make sure to explain everything as clearly as I can; I try to make sure the patients understand that Flo isn’t a real person, she’s a computer system that will send them text messages, like a helpful friend.  We do sometimes have patients who aren’t keen because they feel like “Big Brother is watching them”, but the majority say “Yeah I’ll give it a go!”.  I don’t have many patients that drop or opt out, so obviously they don’t mind using Flo and think that she’s a good idea.

We do get occasional feedback from patients; I ask them how they’re doing, and how they’re getting on.  Patients tell me their epilepsy is much improved, and that they found Flo useful; as far as I know, I’ve not heard any negative feedback from my patients who use Flo.   I think that it is convenient for patients, particularly teenagers, as they always have their phone with them, and Flo’s messages aren’t intrusive.


Using Flo as a clinician


As I started using Flo I found that it was plain sailing – it was simple and easy for me to get to grips with and use.  We do have some issues where patients come in and when I ask if they are still getting messages from Flo, and they say “Oh no I’ve changed my phone number”, but they haven’t told me.  I know that could be helped if there were some messages where Flo would ask them to reply, but I would prefer to keep things simple and light-touch for my patients.  I think that sometimes when you put too much demand on patients, they can withdraw from it to a certain extent.

In terms of me using Flo day to day with patients, I find Flo very useful and very accessible.  With the PC that I use in clinic, I can just open up Flo online and add protocols or patients with their phone number there and then. The ease of it is very, very good, and I would recommend Flo to other clinicians.

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Patient Evaluation

Conor has also been developing some patient evaluation questions that Flo can send to his patients.
  • Does Flo help you to remember to take your medication as prescribed?
  • Has Flo helped you to self-manage your condition better?
  • Would you recommend Flo to your friends and family? 


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Of the patients who responded, all told us that they found Flo helped them to remember to take their medication and that they would recommend Flo to friends and family, while all but 1 patient told us that they thought Flo had helped them to self-manage their epilepsy better.  This feedback is very promising, and demonstrates how Flo is helping patients to take care of their health and self-manage their care better.

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