Reddy Ashok, Huseman Tiffany L, Canamucio Anne, Marcus Steven C, Asch David A, Volpp Kevin, Long Judith A
Division of General Internal Medicine, University of Washington School of Medicine, Seattle, WA, USA.
UW Medicine Center for Scholarship in Patient Care Quality and Safety, Seattle, WA, USA.
J Gen Intern Med. 2017 Mar;32(3):256-261. doi: 10.1007/s11606-016-3858-0. Epub 2016 Sep 9.
Simple nudges such as reminders and feedback reports to either a patient or a partner may facilitate improved medication adherence.
To test the impact of a pill bottle used to monitor adherence, deliver a daily alarm, and generate weekly medication adherence feedback reports on statin adherence.
Three-month, three-arm randomized clinical trial (ClinicalTrials.gov identifier: NCT02480530).
One hundred and twenty-six veterans with known coronary artery disease and poor adherence (medication possession ratio <80 %).
Patients were randomized to one of three groups: (1) a control group (n = 36) that received a pill-monitoring device with no alarms or feedback; (2) an individual feedback group (n = 36) that received a daily alarm and a weekly medication adherence feedback report; and (3) a partner feedback group (n = 54) that received an alarm and a weekly feedback report that was shared with a friend, family member, or a peer. The intervention continued for 3 months, and participants were followed for an additional 3 months after the intervention period.
Adherence as measured by pill bottle. Secondary outcomes included change in LDL (mg/dl), patient activation, and social support.
During the 3-month intervention period, medication adherence was higher in both feedback arms than in the control arm (individual feedback group 89 %, partner feedback group 86 %, control group 67 %; p < 0.001 and = 0.001). At 6 months, there was no difference in medication adherence between either of the feedback groups and the control (individual feedback 60 %, partner feedback 52 %, control group 54 %; p = 0.75 and 0.97).
Daily alarms combined with individual or partner feedback reports improved statin medication adherence. While neither an individual feedback nor partner feedback strategy created a sustainable medication adherence habit, the intervention itself is relatively easy to implement and low cost.
诸如向患者或其伴侣发送提醒和反馈报告等简单的助推措施可能有助于提高药物依从性。
测试一种用于监测依从性、每日发出警报并生成每周药物依从性反馈报告的药瓶对他汀类药物依从性的影响。
为期三个月的三臂随机临床试验（ClinicalTrials.gov标识符：NCT02480530）。
126名已知患有冠状动脉疾病且依从性差（药物持有率<80%）的退伍军人。
患者被随机分为三组之一：（1）对照组（n = 36），接受无警报或反馈的药丸监测设备；（2）个人反馈组（n = 36），接受每日警报和每周药物依从性反馈报告；（3）伴侣反馈组（n = 54），接受警报和与朋友、家庭成员或同龄人共享的每周反馈报告。干预持续3个月，干预期后对参与者再随访3个月。
通过药瓶测量的依从性。次要结果包括低密度脂蛋白（mg/dl）的变化、患者激活度和社会支持。
在3个月的干预期内，两个反馈组的药物依从性均高于对照组（个人反馈组89%，伴侣反馈组86%，对照组67%；p<0.001和=0.001）。在6个月时，任何一个反馈组与对照组之间的药物依从性均无差异（个人反馈60%，伴侣反馈52%，对照组54%；p = 0.75和0.97）。
每日警报结合个人或伴侣反馈报告可提高他汀类药物的依从性。虽然个人反馈和伴侣反馈策略都未形成可持续的药物依从性习惯，但该干预本身相对易于实施且成本较低。
