Behavioral Economics to improve Antihypertensive Therapy Adherence (BETA)

项目总结 高血压是最普遍的心血管疾病风险因素之一，超过45%的美国人 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因素是使用药物来 降低血压。不幸的是，超过50%的美国人表现出不遵守药物治疗的行为 直接导致血压控制不佳的统计数据，因此过度控制是可以预防的 心血管事件。强有力的数据表明，将服药与日常生活联系起来(“锚定”) 提高遵从性，然而，基于这些信息的现有干预措施未能成功地创造、 长期改善服药依从性。这项研究旨在利用行为经济学的洞察力 提高抗高血压药物的服药依从性。具体地说，我们建议补充链接 每天服用药物，并添加两种成分，使参与者更容易坚持自己的 锚定计划：通过频繁的短信和断断续续的提供来提高信息的显著程度 根据锚定计划服药的奖励。这项研究将在试点中随机实施 大容量临床实践中的对照试验(RCT)，以确定可行性、可接受性和初步 功效。具体目标包括：1)发展干预措施并评估其可行性的形成阶段 通过有关键利益相关者的焦点小组进行的可接受性；2)对60名高血压患者进行的随机对照试验 对照组(n=20)给予常规锚定用药教育和两次干预 小组，一组(n=20)接受锚定教育和日常短信提醒，另一组(n=20) 它接受锚定教育、文本消息和财务奖励，以根据 他们的锚定计划；以及3)为未来的R01应用程序做准备的数据收集，包括焦点小组 与关键利益相关者(患者、提供者[医生、护士、高级护理从业者、 药剂师]和诊所工作人员)和退出焦点小组与研究参与者讨论如何改善 干预。主要假设是：通过将服药固定在现有程序上，干预是有效的， 通过将池(消息组+激励组)与控制组进行比较进行测试。第二个 假设是：在短信中添加激励措施对例行化服药(测试结果)更有效 在激励组与消息组中)。这项研究的结果有可能极大地提高我们的 高血压患者服药依从性障碍及促进剂的了解 潜在地为低成本和可扩展的干预措施提供证据，以改善临床用药依从性 练习一下。

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.