一项随机对照行为干预试验，旨在提高成年中风患者对药物治疗的依从性，采用定制处方短信服务（SMS）——中风短信4研究。

A randomized controlled behavioral intervention trial to improve medication adherence in adult stroke patients with prescription tailored Short Messaging Service (SMS)-SMS4Stroke study.

作者信息

Kamal Ayeesha Kamran, Shaikh Quratulain, Pasha Omrana, Azam Iqbal, Islam Muhammad, Memon Adeel Ali, Rehman Hasan, Akram Masood Ahmed, Affan Muhammad, Nazir Sumaira, Aziz Salman, Jan Muhammad, Andani Anita, Muqeet Abdul, Ahmed Bilal, Khoja Shariq

机构信息

Stroke Services, Section of Neurology, Department of Medicine, The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Aga Khan University, Stadium Road, 74800, Karachi, Pakistan.

Fogarty Cerebrovascular Research Fellow, The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Aga Khan University, Karachi, Pakistan.

出版信息

BMC Neurol. 2015 Oct 21;15:212. doi: 10.1186/s12883-015-0471-5.

DOI:10.1186/s12883-015-0471-5

PMID:26486857

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4618367/

Abstract

BACKGROUND

The effectiveness of mobile technology to improve medication adherence via customized Short Messaging Service (SMS) reminders for stroke has not been tested in resource poor areas. We designed a randomized controlled trial to test the effectiveness of SMS on improving medication adherence in stroke survivors in Pakistan.

METHODS

This was a parallel group, assessor-blinded, randomized, controlled, superiority trial. Participants were centrally randomized in fixed block sizes. Adult participants on multiple medications with access to a cell phone and stroke at least 4 weeks from onset (Onset as defined by last seen normal) were eligible. The intervention group, in addition to usual care, received reminder SMS for 2 months that contained a) Personalized, prescription tailored daily medication reminder(s) b) Twice weekly health information SMS. The Health Belief Model and Social Cognitive theory were used to design the language and content of messages. Frontline SMS software was used for SMS delivery. Medication adherence was self-reported and measured on the validated Urdu version of Morisky Medication Adherence Questionnaire. Multiple linear regression was used to model the outcome against intervention and other covariates. Analysis was conducted by intention-to-treat principle.

RESULTS

Two hundred participants were enrolled. 38 participants were lost to follow-up. After 2 months, the mean medication score was 7.4 (95 % CI: 7.2-7.6) in the intervention group while 6.7 (95 % CI: 6.4-7.02) in the control group. The adjusted mean difference (Δ) was 0.54 (95 % CI: 0.22-0.85). The mean diastolic blood pressure in the intervention group was 2.6 mmHg (95 % CI; -5.5 to 0.15) lower compared to the usual care group.

CONCLUSION

A short intervention of customized SMS can improve medication adherence and effect stroke risk factors like diastolic blood pressure in stroke survivors with complex medication regimens living in resource poor areas.

TRIAL REGISTRATION

Clinicaltrials.gov NCT01986023 last accessed at https://clinicaltrials.gov/ct2/show/NCT01986023.

摘要

背景

在资源匮乏地区，尚未对移动技术通过定制短信服务（SMS）提醒来提高中风患者药物依从性的有效性进行测试。我们设计了一项随机对照试验，以测试短信对提高巴基斯坦中风幸存者药物依从性的有效性。

方法

这是一项平行组、评估者盲法、随机、对照、优效性试验。参与者按固定的区组大小进行集中随机分组。成年参与者正在服用多种药物，可使用手机，且中风发病至少4周（发病定义为最后一次正常状态）符合条件。干预组除接受常规护理外，还接收为期2个月的提醒短信，其中包含：a）个性化、根据处方定制的每日用药提醒；b）每周两次的健康信息短信。健康信念模型和社会认知理论用于设计短信的语言和内容。使用一线短信软件发送短信。药物依从性通过在经过验证的乌尔都语版莫里西药物依从性问卷上进行自我报告和测量。使用多元线性回归对干预及其他协变量的结果进行建模。分析按照意向性分析原则进行。

结果

招募了200名参与者。38名参与者失访。2个月后，干预组的平均用药得分是7.4（95%置信区间：7.2 - 7.6），而对照组为6.7（95%置信区间：6.4 - 7.02）。调整后的平均差值（Δ）为0.54（95%置信区间：0.22 - 0.85）。与常规护理组相比，干预组的平均舒张压低2.6 mmHg（95%置信区间；-5.5至0.15）。