Trial to Examine Text Message-Based mHealth in Emergency Department Patients With Diabetes (TExT-MED): A Randomized Controlled Trial
Trial to Examine Text Message-Based mHealth in Emergency Department Patients With Diabetes (TExT-MED): A Randomized Controlled Trial
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DOI：
10.1016/j.annemergmed.2013.10.012
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发表时间：
2014-06-01
影响因子：
6.2
通讯作者：
Menchine, Michael
中科院分区：
文献类型：
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作者：
Arora, Sanjay;Peters, Anne L.;Menchine, Michael
研究目的：越来越多的低收入内城糖尿病患者使用急诊科(EDs)进行急慢性护理。我们试图确定一种可扩展的、低成本的、单向的、基于短信的移动健康干预(Text-MED)是否可以改善临床结果，增加健康行为，并减少在安全网人群中对ED的使用。方法：我们在城市公共ED中对128名控制不佳的成年糖尿病患者(糖化血红蛋白水平=8%)进行了随机对照试验。Text-MED组在6个月的时间里每天收到2条英语或西班牙语的短信。主要结果是Hb A(1C)水平的变化。次要结果包括服药依从性、自我效能、自我护理任务执行情况、生活质量、糖尿病相关知识、ED利用和患者满意度的变化。结果：6个月时，Text-MED组Hb A(1C)水平下降1.05%，而对照组下降0.60%(Delta 0.45；95%可信区间[CI]-0.27至1.17)。次要结果有利于Text-MED组，在自我报告的服药依从性方面观察到最大的变化(由Morisky药物依从性量表衡量，8分验证量表得分较高，代表更好的依从性)，Text-MED组从4.5改善到5.4，而对照组净减少-0.1(Delta 1.1[95%CI 0.1到2.1])。在Text-MED组中，说西班牙语的人在服药依从性方面的影响更大(1.1比-0.3；Delta 1.4；95%CI 0.2到2.7)和Hb A(1C)(-1.2%比-0.4%)。在TEXT-MED组中，使用急救服务的患者比例呈下降趋势(35.9%比51.6%；Delta 15.7%；95%CI 9.4%比22%)。总体而言，93.6%的受访者喜欢Text-MED，100%的受访者会将其推荐给家人/朋友。结论：Text-MED计划没有导致Hb A(1C)的统计学意义上的改善。然而，观察到HB-AIL的主要结果和包括生活质量在内的其他次要结果的改善趋势，最显著的是改善了服药依从性。TEXT-MED还降低了ED的利用率。这些发现在说西班牙语的小组中被放大了。Text-MED等技术为安全网ED人群提供了高度可扩展、低成本且可广泛使用的解决方案。
Study objective: Increasingly, low-income inner-city patients with diabetes utilize emergency departments (EDs) for acute and chronic care. We seek to determine whether a scalable, low-cost, unidirectional, text message-based mobile health intervention (TExT-MED) improves clinical outcomes, increases healthy behaviors, and decreases ED utilization in a safety net population.Methods: We conducted an randomized controlled trial of 128 adult patients with poorly controlled diabetes (glycosylated hemoglobin [Hb A(1C)] level >= 8%) in an urban, public ED. The TExT-MED group received 2 daily text messages for 6 months in English or Spanish. The primary outcome was change in Hb A(1C) level. Secondary outcomes included changes in medication adherence, self-efficacy, performance of self-care tasks, quality of life, diabetes-specific knowledge, ED utilization, and patient satisfaction.Results: Hb A(1C) level decreased by 1.05% in the TEXT-MED group compared with 0.60% in the controls (Delta 0.45; 95% confidence interval [Cl] -0.27 to 1.17) at 6 months. Secondary outcomes favored the TEXT-MED group, with the most sizable change observed in self-reported medication adherence (as measured by the Morisky Medication Adherence Scale, an 8-point validated scale with higher scores representing better adherence), which improved from 4.5 to 5.4 in the TEXT-MED group compared with a net decrease of -0.1 in the controls (Delta 1.1 [95% CI 0.1 to 2.1]). Effects were larger among Spanish speakers for both medication adherence (1.1 versus -0.3; Delta 1.4; 95% CI 0.2 to 2.7) and Hb A(1C) (-1.2% versus -0.4%) in the TEXT-MED group. The proportion of patients who used emergency services trended lower in the TExT-MED group (35.9% versus 51.6%; Delta 15.7%; 95% Cl 9.4% to 22%). Overall, 93.6% of respondents enjoyed TExT-MED and 100% would recommend it to family/friends.Conclusion: The TEXT-MED program did not result in a statistically significant improvement in Hb A(1C). However, trends toward improvement in the primary outcome of Hb AIL and other secondary outcomes, including quality of life, were observed, the most pronounced being improved medication adherence. TExT-MED also decreased ED utilization. These findings were magnified in the Spanish-speaking subgroup. Technologies such as TEXT-MED represent highly scalable, low-cost, and widely accessible solutions for safety-net ED populations.