Pernell B M, DeBaun Michael R, Becker Kathleen, Rodeghier Mark, Bryant Valencia, Cronin Robert M
Robert M. Cronin, Department of Biomedical Informatics, Vanderbilt University Medical Center, 2525 West End Suite 1475, Nashville, TN 37203, USA, Email: robert.cronin@ vanderbilt.edu.
Appl Clin Inform. 2017 May 24;8(2):541-559. doi: 10.4338/ACI-2016-12-RA-0203.
Sickle cell disease (SCD) is a childhood and adult disease that primarily affects African Americans, characterized by life threatening sequelae mitigated by medications. One-way and two-way short message service (SMS) medication reminders have differing efficacy in chronic diseases. There is limited literature about SMS medication reminders in SCD.
The goal of this study was to test the feasibility, defined by recruitment/acceptance, retention/attrition, and technology utilization, of two-way SMS medication reminders in individuals with SCD with and without asthma.
Participants were randomly allocated to standard care or reminders. Two-way SMS reminders were automated using Research Electronic Data Capture (REDCap) for hydroxyurea, fluticasone, budesonide and montelukast. Adherence was measured using the Morisky Medication Adherence Scale-8 (MMAS-8). Asthma control was assessed using the Childhood and Adult-Asthma Control Tests (ACT). Participants were enrolled 28 to 60 days with a common termination date.
The recruitment rate was 95% (47/49) and 82.9% completed the study. Among the 47 study participants enrolled, 51.1% were male, 61.7% were adults, median age was 20 (range: 3 to 59), and 98% were African Americans. Of the 26 participants receiving messages, 20% responded on over 95% of the days and usage varied with an average response rate of 33%, ranging from 21% to 46%. Medication adherence scores improved significantly in the intervention group (3.42 before, 5.46 after; p=0.002), but not in the control group (3.90 before, 4.75 after; p=0.080). Childhood-ACT scores improved in the intervention group (19.20 before, 24.25 after). Adult-ACT scores within the intervention arm were unchanged (21.0 before, 22.0 after. ACT scores did not improve significantly.
This study demonstrated the feasibility for two-way SMS medication reminders to improve medication adherence in a high-risk population where daily medication adherence is critical to health outcomes and quality of life.
镰状细胞病（SCD）是一种主要影响非裔美国人的儿童及成人疾病，其特征为存在可通过药物缓解的危及生命的后遗症。单向和双向短信服务（SMS）药物提醒在慢性病中的疗效有所不同。关于SCD中短信药物提醒的文献有限。
本研究的目的是测试双向短信药物提醒在患有和未患有哮喘的SCD患者中的可行性，可行性由招募/接受情况、留存/损耗情况和技术使用情况来定义。
参与者被随机分配至标准护理组或提醒组。使用研究电子数据采集（REDCap）对羟基脲、氟替卡松、布地奈德和孟鲁司特进行双向短信提醒自动化设置。使用Morisky药物依从性量表8（MMAS-8）测量依从性。使用儿童和成人哮喘控制测试（ACT）评估哮喘控制情况。参与者入组28至60天，有共同的终止日期。
招募率为95%（47/49），82.9%的参与者完成了研究。在入组的47名研究参与者中，51.1%为男性，61.7%为成年人，年龄中位数为20岁（范围：3至59岁），98%为非裔美国人。在26名接收短信的参与者中，20%在超过95%的日子里有回复，使用率各不相同，平均回复率为33%，范围为21%至46%。干预组的药物依从性得分显著提高（之前为3.42，之后为5.46；p=0.002），但对照组未提高（之前为3.90，之后为4.75；p=0.080）。干预组的儿童ACT得分有所提高（之前为19.20，之后为24.25）。干预组内的成人ACT得分未改变（之前为21.0，之后为22.0。ACT得分未显著提高。
本研究证明了双向短信药物提醒在高危人群中提高药物依从性的可行性，在该人群中，每日药物依从性对健康结果和生活质量至关重要。
