1 Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
2 Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Cephalalgia. 2018 Dec;38(14):2035-2044. doi: 10.1177/0333102418756864. Epub 2018 Apr 10.
Effective management of migraine requires adherence to treatment recommendations; however, adolescents with migraine take their daily medications only 75% of the time. Low-cost adherence-focused interventions using technology may improve adherence, but have not been investigated.
Thirty-five adolescents and young adults (13-21 years) with migraine participated in an AB-design pilot study to assess the use of a mobile phone adherence-promotion application ("app") and progressive reminder system. Adherence was calculated using electronic monitoring during the baseline period and medication adherence intervention.
Relative to baseline, adherence significantly improved during the first month of the intervention. Specifically, improvements existed for older participants with lower baseline adherence. Self-reported app-based adherence rates were significantly lower than electronically monitored adherence rates. Participants rated the intervention as acceptable and easy to use.
"Apps" have the potential to improve medication adherence and are a promising intervention for adolescents and young adults with low adherence. Involving parents in the intervention is also helpful. Providers should assess barriers to adherence and use of technology-based interventions, encourage parents to incorporate behavioral incentives, and provide referrals for more intensive interventions to improve long-term outcomes. Further, tracking adherence in an app may result in an underestimation of adherence. Future full-scale studies should be conducted to examine adherence promotion app interventions.
有效的偏头痛管理需要遵循治疗建议；然而，偏头痛青少年每天只服用药物的时间仅为 75%。使用成本低廉的、以关注患者遵医行为的技术干预措施可能会提高遵医行为，但目前尚未进行相关研究。
35 名患有偏头痛的青少年和年轻人（13-21 岁）参与了一项 AB 设计的试点研究，以评估使用手机遵医行为促进应用程序（“应用程序”）和渐进式提醒系统。在基线期和药物依从性干预期间，通过电子监测计算依从性。
与基线相比，干预后的第一个月，患者的依从性显著提高。具体来说，对于基线依从性较低的年龄较大的参与者，改善效果更明显。基于应用程序的自我报告的依从率明显低于电子监测的依从率。参与者对干预措施的评价是可以接受的和易于使用的。
“应用程序”有可能提高药物的依从性，是一种有前途的针对低依从性的青少年和年轻人的干预措施。让父母参与干预也很有帮助。提供者应评估依从性的障碍和基于技术的干预措施的使用情况，鼓励父母采用行为激励措施，并提供更强化的干预措施的转介，以改善长期结果。此外，在应用程序中追踪依从性可能会导致对依从性的低估。未来应进行全面的研究，以检验促进药物依从性的应用程序干预措施。
