BETTER-BP (Behavioral Economics Trial To Enhance Regulation of Blood Pressure)

BETTER-BP（加强血压调节的行为经济学试验）

• 批准号: 10227750
• 负责人: John A Dodson
• 金额: $ 78.82万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-17 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10227750
• 关键词: Address; Adherence; Age; Antihypertensive Agents; Behavior; Behavioral; Blood Pressure; Cardiovascular Diseases; Categories; Cellular Phone; Clinic; Clinical Trials; Counseling; Drug Prescriptions; Ethnic Origin; Event; Foundations; Health; Health Care Costs; Health Status; Health behavior; Health system; Hospitalization; Hospitals; Human; Hypertension; Incentives; Institution; Intervention; Lead; Link; Measures; Medicaid; Minority; Motivation; Myocardial Infarction; New York City; Outcome; Outpatients; Overweight; Participant; Patient Education; Patient Recruitments; Patients; Pattern; Pharmaceutical Preparations; Population Heterogeneity; Prevention strategy; Public Hospitals; Race; Randomized; Regrets; Reporting; Research; Research Personnel; Resources; Scientist; Self Efficacy; Stroke; System; Testing; Translating; Vulnerable Populations; Work; arm; base; behavior change; behavioral economics; blood pressure reduction; blood pressure regulation; cardiovascular disorder epidemiology; cardiovascular disorder risk; clinical practice; comorbidity; cost; depressive symptoms; design; disadvantaged population; experience; financial incentive; group intervention; improved; incentive program; incentive strategies; medication compliance; medication nonadherence; monitoring device; mortality; novel strategies; patient engagement; pill; pragmatic trial; programs; randomized trial; recruit; sex; smartphone Application; socioeconomic disadvantage; socioeconomics; success; treatment arm

PROJECT SUMMARY Adherence to antihypertensive medications remains unacceptably low despite decades of research. This is especially true in vulnerable populations (socioeconomically disadvantaged and/or minority) who simultaneously experience the highest rates of adverse hypertension-related sequelae (e.g. myocardial infarction, stroke), and have the lowest levels of adherence. Studies to date targeted at improving adherence, such as patient education and counseling, have yielded some success but are often resource-intensive and not scalable across institutions. Behavioral economic approaches have recently been developed to enhance medication adherence; these strategies aim to leverage innately human tendencies (such as overweighting of immediate benefits) in order to improve health behaviors. To date, several behavioral economic-based studies using a lottery incentive program (“regret lottery”) approach, whereby participants are encouraged to undertake healthy behaviors through the desire to avoid regret over losing financial incentives, have been promising. However, whether these incentives translate to sustainable behavior change in vulnerable populations is unclear. In this context we propose BETTER-BP (Behavioral Economics Trial To Enhance Regulation of Blood Pressure), a pragmatic randomized trial within the New York City Health and Hospitals (NYC-H+H) system, which is the largest public hospital system in the U.S. and serves a diverse and disadvantaged population. Our trial will recruit from 3 NYC-H+H ambulatory clinics, and will use a lottery incentive program to promote adherence to antihypertensive medication that will be delivered via smartphone for 6 months. Participants will be followed for a total of 12 months to examine durable effects. We will randomize 435 patients with hypertension determined to have poor adherence (<80% adherence with antihypertensive medication), in a 2:1 (intervention:control) ratio. In Aim 1 we will evaluate the effects of the incentive lottery on ambulatory systolic blood pressure (SBP) and adherence (good adherence defined by ≥80% days adherent) between intervention and control arms at 6 months. We hypothesize that the incentive lottery will reduce SBP by ≥10 mmHg compared with control, and that more participants receiving the lottery will be adherent. In Aim 2 we will examine durable effects of the lottery on SBP and adherence at 12 months. In Aim 3, we will analyze trajectories of adherence among participants assigned to the intervention group, as well as predictors of category membership. The PI for this project (Dr. Dodson) is a cardiologist and Early Stage Investigator with experience in cardiovascular epidemiology and clinical trials. Co-I’s are Dr. Troxel, a biostatistician and expert in behavioral economic clinical trials, and Dr. Schoenthaler, a behavioral scientist with expertise in adherence and patient engagement. The results could lead to sustainable and scalable strategies to improve antihypertensive adherence and BP control among socioeconomically vulnerable patients.

项目总结