Digital health for medication adherence among African Americans with hypertension

摘要：在Patricia Weitzman博士的领导下，一个由临床医生和 研究人员将合作开发、形式化地测试和评估数字提供商的短期有效性 平台名为Memento.HTN，与患者短信文本系统集成，旨在支持药物治疗 患有高血压(HTN)的非裔美国人的坚持。HTN对非洲人来说更常见，破坏性更大 美国人比其他任何种族的人都要多。超过一半的非裔美国成年人，约1500万人， HTN.此外，与白人相比，非裔美国人坚持服用HTN药物的可能性要低4倍 对口单位。为减少HTN发病率和死亡率的种族差距而量身定做的方法，特别是那些支持 坚持用药，是初级保健所需要的。这种方法必须克服因成本或地理位置而造成的障碍 可以阻止非裔美国患者获得依从性支持的距离。这些方法还必须 克服来自医疗保健系统本身的遵从性支持提供障碍。重要的是，HTN是 Covid19住院中最常见的并发症之一，尤其是非裔美国人(CDC 2020)。 此外，媒体对某些被称为RAAS抑制剂的HTN药物与严重Covid19之间可能存在联系的报道 结果可能让HTN患者对他们的药物的安全性感到震惊。因此，行政协调会(2020年3月)迅速 发布的指南建议所有患者在大流行期间坚持服用HTN药物，除非他们的医生建议， 因为没有证据表明HTN药物与Covid19严重程度之间存在联系。因此，在《公约》第19条中，支持 患有HTN的非裔美国人的用药依从性是极其紧迫的。Memento.HTN在三个关键方面进行了创新 方式：1)据我们所知，它是HTN有史以来第一个链接的数字提供商平台和患者短信文本系统 药物依从性。2)它是为患有HTN的非裔美国人量身定做的。3)具有独特的监控功能 允许提供者监控个人患者依从性的功能；支持处于 增加不遵守的风险；并按药物类别、药片格式和患者人口统计跟踪团体依从率， 其从未被包括在任何数字医学坚持干预中。因此，Memento.HTN系统极大地 简化并促进提供商向患者提供依从性支持，同时增强他们的临床治疗能力。 提供商平台向患者发送交互式短信-文本药丸提醒以及文化敏感的激励， 教育、精神/压力支持和可定制的文本，以及针对故意不遵守和 Covid19相关问题。短信直接发送到患者的手机上(不需要移动应用程序)，进行干预 没有智能手机的患者可以访问。重要的是，Memento允许双向短信交流 在提供者和患者之间，并在患者有临床意义的药片失效时自动提醒提供者。我们 我相信Memento具有巨大的商业潜力，因为EHG已经制定了多重数字计划 将一起向服务于大量高危患者的诊所销售的依从性干预措施。这个B2B 商业模式可以为客户带来收入的大幅增加，使我们的产品从 从财务和健康角度来看。

Abstract: Under the leadership of Patricia Weitzman, PhD, a multicultural, multidisciplinary team of clinicians and researchers will collaborate to develop, formatively test, and evaluate the short-effectiveness of a digital provider platform, called Memento.HTN, that is integrated with a patient SMS text system, and designed to support medication adherence by African Americans with hypertension (HTN). HTN is more common and more destructive for African Americans than for any other ethnic group. More than half of African American adults, about 15 million people, have HTN. Furthermore, African Americans are 4 times less likely to adhere to HTN medications compared to their white counterparts. Tailored approaches to reduce the racial gap in HTN morbidity and mortality, particularly those that support medication adherence, are needed in primary care. Such approaches must overcome barriers due to cost or geographic distance that can prevent African American patients from accessing adherence support. These approaches must also overcome barriers to the delivery of adherence support that stem from healthcare systems themselves. Importantly, HTN is one of most common co-morbidities in Covid19 hospitalizations, particularly for African Americans (CDC 2020). Moreover, media coverage of a possible link between certain HTN meds, called RAAS inhibitors, and severe Covid19 outcomes may have alarmed HTN patients about the safety of their meds. As a result, the ACC (March, 2020) promptly issued guidelines recommending all patients adhere to HTN meds during the pandemic unless advised by their physicians, as there is no evidence of a link between HTN drugs and Covid19 severity. Thus, in the time of Covid19, supporting medication adherence of African Americans with HTN is extremely urgent. Memento.HTN is innovative in three key ways: 1) To our knowledge, it is the first-ever linked digital provider platform and patient SMS text system for HTN medication adherence. 2) It is culturally-tailored for African Americans with HTN. 3) It has unique monitoring functionality allowing providers to monitor individual patient adherence; support `new start' patients, who are at increased risk for non-adherence; and track group adherence rates by drug class, pill format, and patient demographics, which have never been included in any digital med adherence intervention. Thus, the Memento.HTN system greatly simplifies and facilitates provider delivery of adherence support to patients, while enhancing their clinical therapeutics. The provider platform sends patients interactive SMS-text pill reminders plus culturally-sensitive motivational, educational, spiritual/stress-supportive, and customizable texts, along with texts targeting intentional non-adherence and Covid19-related concerns. Texts go directly to patient cellphones (no mobile app needed), making the intervention accessible to patients who do not possess smartphones. Importantly, Memento allows 2-way texting communication between providers and patients, and automatically alerts providers when a patient has a clinically-significant pill lapse. We believe Memento has significant commercial potential, as EHG has already developed plans for multiple digital adherence interventions that will be marketed together to clinics serving large numbers of at-risk patients. This B2B business model can generate large increases in revenues for customers, making our products attractive from both a financial and health perspective.