Sartori Amanda Caroline, Rodrigues Lucena Tiago Franklin, Lopes Camila Takáo, Picinin Bernuci Marcelo, Yamaguchi Mirian Ueda
Cesumar, University Center of Maringá, Paraná, Brazil.
Department of Fundamentals of Education, UEM, State University of Maringa, Parana, Brazil.
Telemed J E Health. 2020 Dec;26(12):1526-1532. doi: 10.1089/tmj.2019.0305. Epub 2020 Mar 6.
Low adherence to pharmacological therapy by patients with diabetes mellitus and hypertension is frequent and represents a worldwide challenge. This study examined the effect of an educational intervention using WhatsApp messaging on medication adherence of patients with hypertension and diabetes. A randomized clinical trial was performed with 403 patients who had diabetes and/or hypertension and who had enrolled in the 33 Basic Health Units of Maringá-PR, Brazil. The patients were randomly assigned to either the intervention group ( = 203), which received usual care (multi-professional educational appointments according to each Unit schedule) plus 55 audio, image or text WhatsApp messages about health care promotion, with an emphasis on medication adherence, or the control group. The control group ( = 200) only received usual care. Medication adherence, as measured by the Morisky-Green Test, was compared through the chi-square test after 16 weeks. Relative risk (RR) was used as a measure of effect size. After the follow-up period (4 months), 67.5% of the patients in the intervention group were adherent versus 58.5% in the control group (RR: 1.15, 95% confidence interval = 0.99-1.34, = 0.077). Although the effect of the intervention was not statistically significant, there was a clinically significant impact associated with a 15% increase in medication adherence. Given the complexity of adherence to the use of antidiabetic and antihypertensive medications, educational interventions using WhatsApp could be useful as a reinforcement to increase adherence to medication.
糖尿病和高血压患者对药物治疗的依从性较低的情况很常见，这是一个全球性的挑战。本研究探讨了使用WhatsApp消息进行教育干预对高血压和糖尿病患者药物依从性的影响。对403名患有糖尿病和/或高血压且已在巴西马林加-巴拉那州的33个基本卫生单位登记的患者进行了一项随机临床试验。患者被随机分配到干预组（n = 203），该组接受常规护理（根据每个单位的时间表进行多专业教育预约），外加55条关于促进医疗保健的音频、图像或文本WhatsApp消息，重点是药物依从性，或对照组。对照组（n = 200）仅接受常规护理。16周后，通过卡方检验比较了用Morisky-Green测试衡量的药物依从性。相对风险（RR）用作效应大小的衡量指标。随访期（4个月）结束后，干预组67.5%的患者依从，而对照组为58.5%（RR：1.15，95%置信区间 = 0.99 - 1.34，p = 0.077）。虽然干预效果在统计学上不显著，但药物依从性提高了15%，具有临床显著影响。鉴于抗糖尿病和抗高血压药物使用依从性的复杂性，使用WhatsApp进行教育干预可能有助于加强药物依从性。
