Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
Acad Emerg Med. 2012 Aug;19(8):949-58. doi: 10.1111/j.1553-2712.2012.01411.x. Epub 2012 Jul 31.
Nonadherence to prescribed medications impairs therapeutic benefits. The authors measured the ability of an automated text messaging (short message service [SMS]) system to improve adherence to postdischarge antibiotic prescriptions.
This was a randomized controlled trial in an urban emergency department (ED) with an annual census of 65,000. A convenience sample of adult patients being discharged with a prescription for oral antibiotics was enrolled. Participants received either a daily SMS query about prescription pickup, and then dosage taken, with educational feedback based on their responses (intervention), or the usual printed discharge instructions (control). A standardized phone follow-up interview was used on the day after the intended completion date to determine antibiotic adherence: 1) the participant filled prescription within 24 hours of discharge and 2) no antibiotic pills were left on the day after intended completion of prescription.
Of the 200 patients who agreed to participate, follow-up was completed in 144 (72%). From the 144, 26% (95% confidence interval [CI] = 19% to 34%) failed to fill their discharge prescriptions during the first 24 hours, and 37% (95% CI = 29% to 45%) had pills left over, resulting in 49% (95% CI = 40% to 57%) nonadherent patients. There were no differences in adherence between intervention participants and controls (57% vs. 45%; p = 0.1). African American race, greater than twice-daily dosing, and self-identifying as expecting to have difficulty filling or taking antibiotics at baseline were associated with nonadherence.
Almost one-half (49%) of our patients do not adhere to antibiotic prescriptions after ED discharge. Future work should improve the design and deployment of SMS interventions to optimize their effect on improving adherence to medication after ED discharge.
不遵医嘱服药会影响治疗效果。作者旨在评估自动化短信系统（SMS）提高患者出院后抗生素服用依从性的效果。
该研究为单中心、前瞻性、随机对照试验，在一家年接诊量 65000 人的城市急诊科进行。纳入对象为成年患者，这些患者出院时带口服抗生素处方，且方便使用短信。试验组患者每天会收到一条关于取药和服药的短信提示，患者根据短信内容回复，系统会依据回复结果提供用药教育反馈；对照组患者仅获得常规的纸质出院医嘱。在出院后计划服药结束日期的次日，通过标准化电话随访来评估患者的抗生素服药依从性：1）患者在出院后 24 小时内取药；2）在计划服药结束日期的次日，患者没有剩余的抗生素药物。
在 200 名同意参加本研究的患者中，有 144 名（72%）完成了随访。在这 144 名患者中，26%（95%可信区间[CI]：19%至 34%）的患者在出院后 24 小时内未取药，37%（95% CI：29%至 45%）的患者在计划服药结束日期的次日仍有剩余药物，因此，49%（95% CI：40%至 57%）的患者服药依从性差。干预组和对照组患者的服药依从性无差异（57% vs. 45%；p = 0.1）。在校正了种族、每日服药次数和患者对服药的预期困难程度后，非洲裔美国人、每日服药 2 次以上和患者对服药的预期困难程度与服药依从性差相关。
近一半（49%）的患者在急诊科出院后不遵医嘱服用抗生素。未来的研究应改进 SMS 干预的设计和实施，以优化其对改善患者出院后服药依从性的效果。
