Text Messaging to Improve Hypertension Medication Adherence in African Americans From Primary Care and Emergency Department Settings: Results From Two Randomized Feasibility Studies
Text Messaging to Improve Hypertension Medication Adherence in African Americans From Primary Care and Emergency Department Settings: Results From Two Randomized Feasibility Studies
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DOI：
10.2196/mhealth.6630
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发表时间：
2017-02-01
影响因子：
5
通讯作者：
Levy, Phillip D.
中科院分区：
文献类型：
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作者：
Buis, Lorraine;Hirzel, Lindsey;Levy, Phillip D.
背景：高血压(HTN)在美国是一个重要的问题，估计有7800万年龄在20岁及以上的美国人患有这种疾病。与HTN相关的健康差异在美国很常见，非洲裔美国人比白人患病率更高，而且病情更严重，发病更早，并发症更多。服药依从性是HTN管理的重要组成部分，但服药依从性往往很差，只是忘记服药经常被认为是原因之一。移动健康(MHealth)策略有可能成为一种低成本和有效的改善服药依从性的方法，也有广泛的应用范围。目的：我们的目标是确定BPMED的可行性、可接受性和初步临床有效性，BPMED是一种旨在通过全自动短信支持改善患有未受控HTN的非裔美国人的服药依从性的干预措施。方法：我们对来自初级保健和急诊科(ED)的非裔美国患者进行了两项平行的、非盲目随机对照试验。在每项试验中，参与者被随机分配接受常规护理或BPMED干预，为期一个月。在基线和一个月的随访中亲自收集数据，评估对服药依从性、收缩压和舒张压(SBP和DBP)、服药依从性自我效能和参与者满意度的影响。结果：共招募58名初级保健和65名ED参与者，保留率分别为91%(53/58)和88%(57/65)。BPMED参与者在用药依从性(平均变化0.9，SD 2.0 vs平均变化0.5，SD 1.5，P=.26)、SBP(平均变化-12.6，SD 24.0 vs平均变化-11.3，SD 25.5 mm Hg，P=.78)和舒张压(平均变化-4.9，SD 13.1 mm Hgvs平均变化-3.3，SD 14.3 mm Hg，P=.54)方面一直表现出更大但不显著的改善。对照组和BPMED参与者在服药依从性自我效能方面略有改善(平均变化0.8，SD 9.8比平均变化0.7，SD 7.0)，但组间没有发现显著差异(P=0.92)。在线性回归分析中，基线SBP是SBP变化的唯一预测因子；入选时SBP较高的参与者在1个月的随访中表现出明显的改善(β=-0.63，P
Background: Hypertension (HTN) is an important problem in the United States, with an estimated 78 million Americans aged 20 years and older suffering from this condition. Health disparities related to HTN are common in the United States, with African Americans suffering from greater prevalence of the condition than whites, as well as greater severity, earlier onset, and more complications. Medication adherence is an important component of HTN management, but adherence is often poor, and simply forgetting to take medications is often cited as a reason. Mobile health (mHealth) strategies have the potential to be a low-cost and effective method for improving medication adherence that also has broad reach.Objective: Our goal was to determine the feasibility, acceptability, and preliminary clinical effectiveness of BPMED, an intervention designed to improve medication adherence among African Americans with uncontrolled HTN, through fully automated text messaging support.Methods: We conducted two parallel, unblinded randomized controlled pilot trials with African-American patients who had uncontrolled HTN, recruited from primary care and emergency department (ED) settings. In each trial, participants were randomized to receive either usual care or the BPMED intervention for one month. Data were collected in-person at baseline and one-month follow-up, assessing the effect on medication adherence, systolic and diastolic blood pressure (SBP and DBP), medication adherence self-efficacy, and participant satisfaction. Data for both randomized controlled pilot trials were analyzed separately and combined.Results: A total of 58 primary care and 65 ED participants were recruited with retention rates of 91% (53/58) and 88% (57/65), respectively. BPMED participants consistently showed numerically greater, yet nonsignificant, improvements in measures of medication adherence (mean change 0.9, SD 2.0 vs mean change 0.5, SD 1.5, P=.26), SBP (mean change -12.6, SD 24.0 vs mean change -11.3, SD 25.5 mm Hg, P=.78), and DBP (mean change -4.9, SD 13.1 mm Hg vs mean change -3.3, SD 14.3 mm Hg, P=.54). Control and BPMED participants had slight improvements to medication adherence self-efficacy (mean change 0.8, SD 9.8 vs mean change 0.7, SD 7.0) with no significant differences found between groups (P=.92). On linear regression analysis, baseline SBP was the only predictor of SBP change; participants with higher SBP at enrollment exhibited significantly greater improvements at one-month follow-up (beta=-0.63, P