Digital health for medication adherence among African Americans with hypertension

摘要：在 Patricia Weitzman 博士的领导下，一支由临床医生和专家组成的多文化、多学科团队 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 名为 Memento.HTN 的平台，与患者 SMS 文本系统集成，旨在支持药物治疗 患有高血压 (HTN) 的非裔美国人的依从性。 HTN 对非洲人来说更为常见，破坏性也更大 美国人比任何其他族裔群体都重要。超过一半的非裔美国成年人（约 1500 万人） HTN。此外，与白人相比，非洲裔美国人坚持服用 HTN 药物的可能性要低 4 倍。 同行。缩小高血压发病率和死亡率种族差距的定制方法，特别是那些支持 药物依从性是初级保健所需要的。这些方法必须克服由于成本或地理原因造成的障碍 距离可能会妨碍非裔美国患者获得依从性支持。这些方法还必须 克服医疗保健系统本身提供依从性支持的障碍。重要的是，HTN 是 这是 Covid19 住院期间最常见的合并症之一，特别是对于非裔美国人而言 (CDC 2020)。 此外，媒体报道了某些称为 RAAS 抑制剂的 HTN 药物与严重 Covid19 之间可能存在的联系 结果可能会让高血压患者对其药物的安全性感到震惊。因此，ACC（2020 年 3 月）立即 发布了指南，建议所有患者在大流行期间坚持服用 HTN 药物，除非医生建议， 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 Covid19 时期，支持 患有高血压的非裔美国人的药物依从性极为紧迫。 Memento.HTN 在三个关键方面进行创新 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商平台和患者 SMS 文本系统 用药依从性。 2) 它是为患有 HTN 的非裔美国人量身定制的文化。 3）具有独特的监控功能 允许提供者监控个体患者依从性的功能；支持处于“新开始”状态的患者 不依从的风险增加；并按药物类别、药丸形式和患者人口统计数据跟踪小组依从率， 这些从未被纳入任何数字医疗依从性干预中。因此，Memento.HTN 系统极大地 简化并促进提供者向患者提供依从性支持，同时增强他们的临床治疗。 提供商平台向患者发送交互式短信服药提醒以及文化敏感的激励、 教育性、精神/压力支持和可定制的文本，以及针对故意不遵守和 与 Covid19 相关的担忧。短信直接发送到患者手机（无需移动应用程序），从而进行干预 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进行交互，并在患者发生具有临床意义的药物失效时自动提醒提供者。我们 相信 Memento 具有巨大的商业潜力，因为 EHG 已经制定了多个数字化计划 依从性干预措施将一起销售给为大量高危患者提供服务的诊所。这个B2B 商业模式可以为客户带来收入的大幅增加，使我们的产品具有吸引力 财务和健康角度。

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.