Text Message Medication Adherence Reminders Automated and Delivered at Scale Across Two Institutions: Testing the Nudge System: Pilot Study.
Text Message Medication Adherence Reminders Automated and Delivered at Scale Across Two Institutions: Testing the Nudge System: Pilot Study.
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DOI：
10.1161/circoutcomes.120.007015
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发表时间：
2021-05
期刊：
影响因子：
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通讯作者：
Bull S
中科院分区：
文献类型：
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作者：
Luong P;Glorioso TJ;Grunwald GK;Peterson P;Allen LA;Khanna A;Waughtal J;Sandy L;Ho PM;Bull S
心血管疾病患者的药物补充行为是次优的。被称为“轻推”的简短行为干预可能会影响药物补充行为，并可以使用短信大规模地向患者提供。在初步研究中确定了至少接受一种高血压、高脂血症、糖尿病、房颤和/或冠状动脉疾病药物处方和填充的患者。入组了符合试验条件的患者（N=400），并有机会选择退出。在试点的第一阶段，我们测试了60名患者的短信发送。在第二阶段，我们通过确定再灌注间隔≥7天的患者并将其随机分配至干预组或对照组来测试干预的可行性。患者被发短信“轻推”，并评估他们是否重新填充药物。在400名发出研究邀请的患者中，56名（14%）选择退出。在第一阶段，我们成功地向60名患者中的58名发送了短信，并通过短信捕获了患者的反应。在II期研究中，286例患者中有207例（72.4%）的一种或多种心血管药物的用药间隔≥7天，并被随机分配至干预组或对照组。入组患者平均年龄61.7岁，主要为男性（69.1%）和白色（72.5%），高血压是最常见的合格疾病（78.7%）。有一种趋势是干预患者更有可能补充至少1种间隙药物（30.6% vs 18.0%; p=0.12）和所有间隙药物（17.8% vs 10.0%; p=0.27）。可以在医疗保健提供系统内设置自动化流程，以识别在药物依从性方面存在差距的患者，并发送“轻推”以促进药物补充。短信“轻推”可能是一种可行和有效的方法，以促进药物补充。目前正在进行一项大型多中心随机试验，以确定基于文本的轻推对总体CVD发病率和死亡率的影响，以进一步探索这一点。 https://clinicaltrials.gov/ct2/show/NCT03973931
Medication refill behavior in patients with cardiovascular diseases is suboptimal. Brief behavioral interventions called “Nudges” may impact medication refill behavior and can be delivered at scale to patients using text messaging. Patients that were prescribed and filled at least one medication for hypertension, hyperlipidemia, diabetes, atrial fibrillation, and/or coronary artery disease were identified for the pilot study. Patients eligible for the pilot (N=400) were enrolled with an opportunity to opt-out. In phase I of the pilot, we tested text message delivery to 60 patients. In phase II, we tested intervention feasibility by identifying those with refill gap of ≥7 days and randomized them to intervention or control arms. Patients were texted “Nudges” and assessed whether they refilled their medications. Of 400 patients sent study invitations, 56 (14%) opted out. In phase I, we successfully delivered text messages to 58 of 60 patients, and captured patient responses via text. In phase II, 207 of 286 (72.4%) patients had a medication gap ≥7 days for one or more cardiovascular medications and were randomized to intervention or control. Enrolled patients averaged 61.7 years old, were primarily male (69.1%) and white (72.5%) with hypertension being the most prevalent qualifying condition (78.7%). There was a trend towards intervention patients being more likely to refill at least 1 gapping medication (30.6% vs 18.0%; p=0.12) and all gapping medications (17.8% vs 10.0%; p=0.27). It is possible to set up automated processes within healthcare delivery systems to identify patients with gaps in medication adherence and send “Nudges” to facilitate medication refills. Text message “Nudges” could potentially be a feasible and effective method to facilitate medication refills. A large multi-site randomized trial to determine the impact of text-based nudges on overall CVD morbidity and mortality is now underway to explore this further. https://clinicaltrials.gov/ct2/show/NCT03973931