Behavioral Economics to improve Antihypertensive Therapy Adherence (BETA)

项目摘要 高血压是最普遍的心血管疾病危险因素之一，超过45%的美国 血压升高的人群。几十年的研究表明，控制血液 压力可以降低严重不良心血管事件的风险，包括中风，心肌梗死， 和心力衰竭成功控制高血压的一个关键组成部分是使用药物， 降低血压不幸的是，超过50%的美国人表现出药物不依从性， 直接导致血压控制不佳的统计数据，因此，过度预防 心血管事件。强有力的数据表明，将服用药物与日常生活联系起来（“锚定”） 增加依从性，然而，建立在此信息基础上的现有干预措施未能成功， 长期改善药物依从性。这项研究旨在利用行为经济学的见解， 提高抗高血压药物的用药依从性。具体来说，我们建议补充链接 每天服用两种添加成分的药物，使参与者更容易坚持他们的 锚定计划：通过频繁的短信和提供间歇性的 根据抛锚计划，给予服药奖励。本研究将在一个试点随机 在大量临床实践中进行对照试验（RCT），以确定可行性、可接受性和初步 功效具体目标包括：（1）形成阶段，以制定干预措施并评估其可行性 和可接受性通过焦点小组与关键利益相关者; 2）随机对照试验的60例高血压患者，其中对照 组（n=20）提供关于将药物服用锚定为日常常规的教育， 组，一组（n=20）接受锚定教育和每日短信提醒，另一组（n=20） 它接收锚定教育，短信，并根据遵守财政激励 他们的锚定计划; 3）为将来的R 01应用做准备的数据收集，包括焦点小组 与关键利益相关者（患者、提供者[医生、护士、高级护理从业人员， 和诊所工作人员）和退出焦点小组与研究参与者就如何改善 干预主要的假设是：干预是有效的，通过锚定服药现有的常规， 通过比较汇总（消息组+激励组）与控制组进行测试。次级 一个假设是：在短信中加入激励措施，对鼓励服药更有效（测试结果 在激励组与消息组中）。这项研究的结果有可能大大提高我们的 了解高血压患者药物依从性的障碍和促进因素， 潜在地为低成本和可扩展的干预提供证据，以改善临床中的药物依从性。 实践

PROJECT SUMMARY Hypertension is one of the most prevalent cardiovascular disease risk factors, with over 45% of the United States population having elevated blood pressure. Decades of research have demonstrated that controlling blood pressure can reduce the risk of serious adverse cardiovascular events including stroke, myocardial infarction, and heart failure. A key component of successfully obtaining control of hypertension is the use of medications to lower blood pressure. Unfortunately, more than 50% of Americans demonstrate medication non-adherence, a statistic that directly contributes to suboptimal blood pressure control and, therefore, excess preventable cardiovascular events. Strong data indicates that linking the taking of medications to daily routines (‘anchoring’) increases adherence, however, existing interventions built on this information have failed to create successful, long term improvements in medication adherence. This study aims to leverage behavioral economic insights to improve medication adherence to antihypertensive medications. Specifically, we propose to complement linking medication taking to a daily routine with two added components to make it easier for participants to stick to their anchoring plan: increasing information salience through frequent text messages and providing intermittent rewards for pill-taking according to the anchoring plan. This study will be implemented in a pilot randomized controlled trial (RCT) in a high-volume clinical practice to establish feasibility, acceptability, and preliminary efficacy. The specific aims include 1) a formative phase to develop the intervention and evaluate its feasibility and acceptability via focus groups with key stakeholders; 2) a RCT of 60 hypertensive patients in which a control group (n=20) is provided education on anchoring medication taking to a daily routine, and two intervention groups, one (n=20) who receives anchoring education and daily text message reminders and another (n=20) which receives anchoring education, text messages, and financial incentives for adherence in accordance with their anchoring plan; and 3) data collection in preparation for a future R01 application, including focus group discussions with key stakeholders (patients, providers [Physicians, Nurses, Advanced Care Practitioners, Pharmacists] and clinic staff) and exit focus groups with study participants regarding ways to improve the intervention. The main hypothesis is: the intervention is effective by anchoring pill-taking to an existing routine, tested by comparing the pooled (Message group + Incentive group) vs. the Control group. The secondary hypothesis is: adding incentives to the text messages is more effective for routinizing pill-taking (testing outcomes in the Incentive group vs. Message group). Outcomes from this study have the potential to greatly enhance our understanding of the barriers and facilitators of medication adherence among hypertensive patients and potentially provide evidence for a low-cost and scalable intervention to improve medication adherence in clinical practice.