Digital health for medication adherence among African Americans with hypertension

翻译后摘要：帕特里夏·韦茨曼，博士，一个多元文化，多学科的临床医生团队的领导下， 研究人员将合作开发、形成性测试和评估数字提供商的短期有效性 HTN平台，该平台与患者SMS文本系统集成，旨在支持药物治疗 非裔美国人高血压（HTN）。HTN在非洲更常见，更具破坏性 美国人比任何其他民族。超过一半的非洲裔美国成年人，约1500万人， HTN。此外，非洲裔美国人坚持HTN药物治疗的可能性是白色美国人的4倍。 同行有针对性的方法，以减少HTN发病率和死亡率的种族差距，特别是那些支持 在初级保健中需要药物依从性。这种方法必须克服由于成本或地理因素造成的障碍。 距离，可以防止非洲裔美国人的患者获得依从性支持。这些方法还必须 克服来自医疗保健系统本身的依从性支持交付障碍。重要的是，HTN是 Covid 19住院治疗中最常见的合并症之一，尤其是非裔美国人（CDC 2020）。 此外，媒体报道某些HTN药物（称为RAAS抑制剂）与严重Covid之间可能存在联系19 这些结果可能会让HTN患者对他们的药物安全性感到担忧。因此，ACC（2020年3月）迅速 发布了指导方针，建议所有患者在大流行期间坚持HTN药物，除非医生建议， 因为没有证据表明HTN药物与Covid 19严重程度之间存在联系。因此，在Covid 19的时候，支持 非裔美国人HTN患者的药物依从性非常紧迫。Memento.HTN在三个关键方面具有创新性 方式：1）据我们所知，这是HTN有史以来第一个链接的数字提供者平台和患者短信文本系统 药物依从性。2)它是为患有HTN的非洲裔美国人量身定制的。3)它有独特的监控功能 允许提供者监测个体患者依从性的功能;支持“新开始”患者， 增加不依从的风险;并通过药物类别、药丸形式和患者人口统计学来跟踪组依从率， 这是从未被纳入任何数字医疗依从性干预的。因此，Memento.HTN系统极大地 简化和促进了提供者向患者提供依从性支持，同时增强了他们的临床治疗。 提供者平台向患者发送交互式SMS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，沿着针对故意不遵守的文本， Covid 19相关问题。短信直接发送到患者手机（无需移动的应用程序）， 没有智能手机的患者也可以使用。重要的是，Memento允许双向短信通信 在提供者和患者之间，并自动提醒提供者，当病人有一个临床上显着的药丸失效。我们 我相信Memento具有巨大的商业潜力，因为EHG已经制定了多个数字 这些干预措施将一起向为大量高危患者提供服务的诊所销售。这个B2B 商业模式可以为客户带来收入的大幅增加，使我们的产品在两个方面都具有吸引力， 财务和健康方面。

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.