A multilevel mHealth intervention boosts adherence to hydroxyurea in individuals with sickle cell disease.
A multilevel mHealth intervention boosts adherence to hydroxyurea in individuals with sickle cell disease.
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DOI：
10.1182/bloodadvances.2023010670
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发表时间：
2023-12-12
期刊：
影响因子：
7.5
通讯作者：
中科院分区：
文献类型：
--
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在SCD和依从性<80%的人群中，通过量身定制的mHealth干预，羟基脲依从性增加了19.8%。mHealth可提高羟基脲的依从性，并与SCD患者自我报告的疼痛和疼痛入院率降低相关。视觉抽象。InCharge Health应用程序使用与羟基脲依从性之间的关系。SCD患者使用InCharge Health应用程序的频率（通过在干预期间使用应用程序的天数百分比测量）与PDC测量的羟基脲依从性的较大变化显著相关（P < .001）。尽管应用程序使用13天与PDC显著增加相关，但在研究期间使用应用程序>50%（≥85天）的患者的PDC平均增加最大（26.9%）。羟基脲可减少镰状细胞病（SCD）并发症，但药物依从性低。我们在一项针对15-45岁SCD患者的多中心、非随机试验中测试了2种移动的健康（mHealth）干预措施，这些干预措施针对患者依从性低（InCharge Health）和提供者处方量低（HU Health）的决定因素。我们比较了干预24周和研究后12周（干预前间隔24周）的覆盖天数百分比（PDC）、实验室检查、医疗保健利用和自我报告的疼痛。我们入组了293例患者（51%为男性;中位年龄27.5岁，86.8%为HbSS/HbSβ0-地中海贫血）。在235名可评估的受试者中，PDC的平均变化增加（39.7%至56.0%; P < 0.001）并持续（39.7%至51.4%，P < 0.001）。平均HbF升高（10.95%至12.78%; P = 0.03）。自我报告的疼痛频率降低（3.54至3.35起事件/年; P = 0.041）。235名参与者中有199名使用InCharge Health ≥1天（84.7%实施;中位使用率：17%研究日; IQR：4.8-45.8%）。对于基线时因疼痛入院次数≥1次的个体，每24周的入院次数从基线到24周（1.97至1.48起事件/患者，P = 0.0045）和第25-36周（1.25起事件/患者，P = 0.0015）有所下降。PDC随着应用程序的使用而增加（P < 0.001），在那些有私人保险的人（P = 0.0078），老年受试者（P = 0.033）和那些疼痛干扰较低的人（P = 0.0012）中效果最大。在89名提供者（49名血液科医生，36名高级护理提供者，4名未报告）中，仅11.2%的人平均使用HU ≥1/月。这种使用不会影响PDC的变化。定制mHealth解决方案以解决羟基脲依从性的障碍，可能会提高依从性并提供临床益处。需要进行明确的随机研究。该试验在www.clinicaltrials.gov上注册为#NCT 04080167。
Hydroxyurea adherence increased by 19.8% with a tailored mHealth intervention in people with SCD and adherence <80%. mHealth boosts hydroxyurea adherence and is associated with reduction in self-reported pain and pain admissions rate in SCD. Visual abstract. Relationship between InCharge Health app use and hydroxyurea adherence. The frequency of InCharge Health app use by individuals with SCD, as measured by the percentage of days the app was used during the intervention period, was significantly associated with greater changes in hydroxyurea adherence (P < .001), as measured by the PDC. Although as little as 13 days of app use was associated with significant PDC increases, patients who used the app for >50% of the duration of the study (≥85 days) saw the greatest mean increase in PDC (26.9%). Hydroxyurea reduces sickle cell disease (SCD) complications, but medication adherence is low. We tested 2 mobile health (mHealth) interventions targeting determinants of low adherence among patients (InCharge Health) and low prescribing among providers (HU Toolbox) in a multi-center, non-randomized trial of individuals with SCD ages 15-45. We compared the percentage of days covered (PDC), labs, healthcare utilization, and self-reported pain over 24 weeks of intervention and 12 weeks post-study with a 24-week preintervention interval. We enrolled 293 patients (51% male; median age 27.5 years, 86.8% HbSS/HbSβ0-thalassemia). The mean change in PDC among 235 evaluable subjects increased (39.7% to 56.0%; P < 0.001) and sustained (39.7% to 51.4%, P < 0.001). Mean HbF increased (10.95% to 12.78%; P = 0.03). Self-reported pain frequency reduced (3.54 to 3.35 events/year; P = 0.041). InCharge Health was used ≥1 day by 199 of 235 participants (84.7% implementation; median usage: 17% study days; IQR: 4.8-45.8%). For individuals with ≥1 baseline admission for pain, admissions per 24 weeks declined from baseline through 24 weeks (1.97 to 1.48 events/patient, P = 0.0045) and weeks 25-36 (1.25 events/patient, P = 0.0015). PDC increased with app use (P < 0.001), with the greatest effect in those with private insurance (P = 0.0078), older subjects (P = 0.033), and those with lower pain interference (P = 0.0012). Of the 89 providers (49 hematologists, 36 advanced care providers, 4 unreported), only 11.2% used HU Toolbox ≥1/month on average. This use did not affect change in PDC. Tailoring mHealth solutions to address barriers to hydroxyurea adherence can potentially improve adherence and provide clinical benefits. A definitive randomized study is warranted. This trial was registered at www.clinicaltrials.gov as #NCT04080167.
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