Electronic Hydroxyurea Adherence: A Multidimensional Electronic Adherence Intervention That Improves Hydroxyurea Adherence in Children With Sickle Cell Disease
Electronic Hydroxyurea Adherence: A Multidimensional Electronic Adherence Intervention That Improves Hydroxyurea Adherence in Children With Sickle Cell Disease
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DOI：
10.2196/13452
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发表时间：
2019-08-08
影响因子：
5
通讯作者：
O'Brien, Sarah H.
中科院分区：
文献类型：
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作者：
Creary, Susan;Chisolm, Deena;O'Brien, Sarah H.
背景：羟基脲是镰状细胞病（SCD）患者的疾病缓解药物。尽管疗效已得到证实，但在临床实践中，羟基脲的不依从性很常见，并导致不依从患者的健康结局更差。移动的直接观察治疗（移动的DOT）是一种针对SCD儿童的中试、电子、多维羟基脲依从性干预。移动的DOT包括向患者发送每日短信提醒服用羟基脲，患者记录并发送每日视频，记录他们的羟基脲给药情况，供研究团队审查和跟踪依从性，向患者提供关于其依从性的个性化反馈，如果患者达到高的羟基脲依从性，则向患者提供小额货币激励。目的：本研究旨在确定移动的DOT是否会增加SCD儿童的羟基脲依从性，并探讨其对血液学和临床结局的影响。方法：这是一项在年龄19岁并报告可使用电子器械的接受羟基脲治疗的SCD患者中进行的单组、6个月干预研究。参与者接受移动的DOT时的羟基脲依从性与接受移动的DOT前和后6个月的依从性进行比较。参与者的药物拥有率（MPR）是根据他们的药房配药记录计算的，并用于衡量依从性。实验室和临床结果从参与者的电子病历中提取。不经常住院的患者谁收到至少160天的干预被认为是从事participator.Results：91例患者谁被接近，55名登记和34从事移动的DOT。参与者的中位年龄为10岁（范围为2-18.8岁），21例（62%，21/34）参与者为男性，28例（82%，21/34）患有血红蛋白SS SCD，19例（56%，19/34）在入组前接受了至少一年的羟基脲处方。使用移动的DOT，参与者的中位数MPR从61.7%增加到84.4%（P
Background: Hydroxyurea is a disease-modifying medication for patients with sickle cell disease (SCD). Despite demonstrated efficacy, hydroxyurea nonadherence in clinical practice is common and results in worse health outcomes for nonadherent patients. Mobile Directly Observed Therapy (Mobile DOT) is a pilot-tested, electronic, multidimensional hydroxyurea adherence intervention for children with SCD. Mobile DOT includes sending daily text message reminders to patients to take hydroxyurea, patients recording and sending daily videos that capture their hydroxyurea administrations for the research team to review and track adherence, providing personalized feedback to patients about their adherence, and providing small monetary incentives to patients if they achieve high hydroxyurea adherence.Objective: This study aimed to determine if Mobile DOT increases hydroxyurea adherence in children with SCD and to explore its impact on hematologic and clinical outcomes.Methods: This was a single-arm, 6-month intervention study of patients with SCD on hydroxyurea who were aged 19 years and reported having access to an electronic device. Participants' hydroxyurea adherence when they received Mobile DOT was compared with their adherence 6 months before and after receiving Mobile DOT. Participants' medication possession ratio (MPR) was calculated from their pharmacy dispensing records and was used to measure adherence. Laboratory and clinical outcomes were abstracted from participants' electronic medical records. Infrequently hospitalized patients who received at least 160 days of the intervention were considered to be engaged participants.Results: Of 91 patients who were approached, 55 enrolled and 34 engaged with Mobile DOT. The median age of the engaged participants was 10 years (range 2-18.8 years), and 21 (62%, 21/34) participants were male, 28 (82%, 21/34) had hemoglobin SS SCD, and 19 (56%, 19/34) were prescribed hydroxyurea for at least a year before enrollment. With Mobile DOT, engaged participants' median MPR increased from 61.7% to 84.4% (P