Impact of Social Determinants of Health and Demographics on Refill Requests by Medicare Patients Using a Conversational Artificial Intelligence Text Messaging Solution: Cross-Sectional Study
Impact of Social Determinants of Health and Demographics on Refill Requests by Medicare Patients Using a Conversational Artificial Intelligence Text Messaging Solution: Cross-Sectional Study
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DOI：
10.2196/15771
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发表时间：
2019-11-18
影响因子：
5
通讯作者：
Prayaga, Ram S.
中科院分区：
文献类型：
--
作者：
Prayaga, Rena Brar;Agrawal, Ridhika;Prayaga, Ram S.
背景资料：慢性病患者的不依从性仍然是一个值得关注的问题，使用短信续药提醒可以有效地提高依从性。然而，关于患者特征和人口统计学特征的差异如何影响使用此通道重新填充的可能性的问题仍然存在。目的：本研究的目的是评估使用会话人工智能的基于SMS的重新填充提醒解决方案的有效性（大赦国际;模拟人类对话的自动化系统）与大型Medicare患者人群进行交互，并探索患者人口统计数据的关联和影响方法：该研究针对99，217名慢性病患者，中位年龄为71岁，从2016年12月至2019年2月使用mPulse移动的交互式短信解决方案进行药物补充。所有患者都是部分遵守或不遵守医疗保险D部分的凯撒永久，南加州，一个大型的综合健康计划的成员。患者收到英文或西班牙文的短信提醒，并使用简单的数字或文本回复来验证他们的身份，查看他们的药物，并完成续药请求。补充请求由Kaiser Permanente药剂师和支持人员处理，并在药房领取或邮寄给患者。描述性统计和预测分析用于检查患者人群及其再填充行为。定性文本分析用于评估会话AI的质量。结果：在研究过程中，向99，217名患者发送了273，356个续药提醒请求，导致47，552个续药请求（17.40%）。这与早期的试点研究结果一致。在要求续杯的患者中，54.81%（26，062/47，552）在提醒后2小时内进行了续杯。有一个很强的负相关关系（r10=-0.93）之间的社会决定因素的健康和补充要求。讲西班牙语者（5149/48，156，10.69%）的续杯请求率显著低于讲英语者（42，389/225，060，18.83%; X-1（2）[n= 273，216]=1829.2; P
Background: Nonadherence among patients with chronic disease continues to be a significant concern, and the use of text message refill reminders has been effective in improving adherence. However, questions remain about how differences in patient characteristics and demographics might influence the likelihood of refill using this channel.Objective: The aim of this study was to evaluate the efficacy of an SMS-based refill reminder solution using conversational artificial intelligence (AI; an automated system that mimics human conversations) with a large Medicare patient population and to explore the association and impact of patient demographics (age, gender, race/ethnicity, language) and social determinants of health on successful engagement with the solution to improve refill adherence.Methods: The study targeted 99,217 patients with chronic disease, median age of 71 years, for medication refill using the mPulse Mobile interactive SMS text messaging solution from December 2016 to February 2019. All patients were partially adherent or nonadherent Medicare Part D members of Kaiser Permanente, Southern California, a large integrated health plan. Patients received SMS reminders in English or Spanish and used simple numeric or text responses to validate their identity, view their medication, and complete a refill request. The refill requests were processed by Kaiser Permanente pharmacists and support staff, and refills were picked up at the pharmacy or mailed to patients. Descriptive statistics and predictive analytics were used to examine the patient population and their refill behavior. Qualitative text analysis was used to evaluate quality of conversational AI.Results: Over the course of the study, 273,356 refill reminders requests were sent to 99,217 patients, resulting in 47,552 refill requests (17.40%). This was consistent with earlier pilot study findings. Of those who requested a refill, 54.81% (26,062/47,552) did so within 2 hours of the reminder. There was a strong inverse relationship (r10=-0.93) between social determinants of health and refill requests. Spanish speakers (5149/48,156, 10.69%) had significantly lower refill request rates compared with English speakers (42,389/225,060, 18.83%; X-1(2) [n=273,216]=1829.2; P