Association of a Smartphone Application With Medication Adherence and Blood Pressure Control The MedISAFE-BP Randomized Clinical Trial
Association of a Smartphone Application With Medication Adherence and Blood Pressure Control The MedISAFE-BP Randomized Clinical Trial
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DOI：
10.1001/jamainternmed.2018.0447
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发表时间：
2018-06-01
影响因子：
39
通讯作者：
Choudhry, Niteesh K.
中科院分区：
文献类型：
--
作者：
Morawski, Kyle;Ghazinouri, Roya;Choudhry, Niteesh K.
重要性药物治疗不依从占未控制高血压的一半。旨在提高依从性的智能手机应用程序（应用程序）广泛使用，但尚未进行严格evaluated.Objective确定Medisafe智能手机应用程序是否改善了自我报告的药物依从性和血压控制。设计，设置和参与者这是一项2臂随机临床试验（药物依从性改善支持应用程序用于参与血压[MedISAFE-BP]）。参与者通过在线平台招募，并邮寄一个家庭血压袖带以确认资格并提供随访测量。在筛选的5577名参与者中，412名完成知情同意，符合入选标准（证实未控制的高血压，服用1至3种抗高血压药物），并以1：干预干预组参与者被指示下载并使用Medisafe应用程序，该应用程序包括提醒警报，依从性报告和可选的同伴支持。主要结局和指标共同主要结局是自报告的药物依从性从基线到12周的变化，通过Morisky药物依从性量表（MMAS）测量（范围，0-8，分数越低表示依从性越低），以及收缩压的变化。（n = 411;干预组209人，对照组202人）的平均年龄为52.0岁，平均身体质量指数为35.5，计算方法为体重（千克）除以身高（米）的平方; 247名（60%）为女性，103名（25%）为黑人。12周后，干预参与者的MMAS平均（5D）评分提高了0.4（1.5），对照组保持不变（组间差异：0.4; 95% CI，0.1-0.7; P= 0.01）。干预组和对照组受试者基线时的平均（SD）收缩压分别为151.4（9.0）mm Hg和151.3（9.4）mm Hg。12周后，平均（SD）收缩压下降了10.6干预参与者为16.0毫米汞柱，对照组为15.4毫米汞柱（组间差异：-0.5; 95% CI，-3.7至2.7; P=.78）.结论和相关性在高血压控制不佳的个体中，与对照组相比，随机使用智能手机应用程序的患者在自我报告的药物依从性方面有小幅改善，但收缩压没有变化。
IMPORTANCE Medication nonadherence accounts for up to half of uncontrolled hypertension. Smartphone applications (apps) that aim to improve adherence are widely available but have not been rigorously evaluated.OBJECTIVE To determine if the Medisafe smartphone app improves self-reported medication adherence and blood pressure control.DESIGN, SETTING, AND PARTICIPANTS This was a 2-arm, randomized clinical trial (Medication Adherence Improvement Support App For Engagement Blood Pressure [MedISAFE-BP]). Participants were recruited through an online platform and were mailed a home blood pressure cuff to confirm eligibility and to provide follow-up measurements. Of 5577 participants who were screened, 412 completed consent, met inclusion criteria (confirmed uncontrolled hypertension, takingl to 3 antihypertensive medications), and were randomized in a ratio of 1:1 to intervention or control.INTERVENTIONS Intervention arm participants were instructed to download and use the Medisafe app, which includes reminder alerts, adherence reports, and optional peer support.MAIN OUTCOMES AND MEASURES Co-primary outcomes were change from baseline to 12 weeks in self-reported medication adherence, measured by the Morisky medication adherence scale (MMAS) (range, 0-8, with lower scores indicating lower adherence), and change in systolic blood pressure.RESULTS Participants (n = 411; 209 in the intervention group and 202 controls) had a mean age of 52.0 years and mean body mass index, calculated as weight in kilograms divided by height in meters squared, of 35.5; 247 (60%) were female, and 103 (25%) were black. After 12 weeks, the mean (5D) score on the MMAS improved by 0.4 (1.5) among intervention participants and remained unchanged among controls (between-group difference: 0.4; 95% Cl, 0.1-0.7; P=.01). The mean (SD) systolic blood pressure at baseline was 151.4 (9.0) mm Hg and 151.3 (9.4) mm Hg, among intervention and control participants, respectively. After 12 weeks, the mean (SD) systolic blood pressure decreased by 10.6 (16.0) mm Hg among intervention participants and 10.1(15.4) mm Hg among controls (between-group difference: -0.5; 95% CI,-3.7 to 2.7; P=.78).CONCLUSIONS AND RELEVANCE Among individuals with poorly controlled hypertension, patients randomized to use a smartphone app had a small improvement in self-reported medication adherence but no change in systolic blood pressure compared with controls.