Neurology Department, Peking University Third Hospital, Beijing, China.
Information Management and Big Data Center, Peking University Third Hospital, Beijing, China.
JMIR Mhealth Uhealth. 2020 Apr 15;8(4):e16496. doi: 10.2196/16496.
Real-world studies have indicated that adherence is important for guaranteeing medication effectiveness. Few studies have tested the feasibility and efficacy of WeChat-based improvement services, via mobile phone, in secondary prevention-specific follow-up among discharged stroke patients.
We evaluated a quadruple-domain, WeChat-based service for ischemic stroke secondary prevention designed to improve treatment adherence of discharged patients. This service focuses on sending reminders for drug use, blood pressure recording, and glucose recording; it also records medication use. We compared the endpoint event rate between WeChat self-monitoring and traditional monitoring.
A cohort study was used to determine the feasibility of a physician-assisted, WeChat-based improvement service and follow-up self-monitoring platform for the secondary prevention of ischemic stroke. The platform was developed by the Peking University Third Hospital based on the information-motivation-behavioral skills model. The overall adherence rate was calculated as the proportion of medication doses verified via uploading. The ischemic endpoint event rate and medication noncompliance rate were compared between traditional prevention monitoring and WeChat self-monitoring. Factors influencing adherence were summarized.
The 1-year follow-up event rate of the WeChat self-monitoring group was 11.9% (12/101), which was less than that of the traditional group (21/157, 13.4%). Compared with the traditional group, the risk ratio of the WeChat group was 0.983 (95% CI 0.895-1.080); this difference was not noted to be significant. The 1-year medication noncompliance ratio tended to be lower in the WeChat monitoring group (3/101, 3.0%) than in the traditional group (11/157, 7.0%; χ=1.9, df=1, P=.16). Of the platform registry participants, 89.7% (210/234: 167 hospital-based and 43 community-based participants) adhered to inputting information into WeChat for 8-96 weeks. The average adherence time was 16.54 (SD 0.80, range 2-24) months. The average decrease in adherence was 4 participants (1.1%) per month. Being a member of a community-based population was an influencing factor for good adherence at the 2-year follow-up (OR 2.373, 95% CI 1.019-5.527, P=.045), whereas transient ischemic attack was an influencing factor for poor adherence at the 2-year follow-up (OR 0.122, 95% CI 0.016-0.940, P=.04).
Use of WeChat self-monitoring showed a trend of increasing medication compliance and decreasing ischemic endpoint event rate compared with traditional monitoring. However, there were ceiling effects in the outcomes, and a relatively small sample size was used. Male participants displayed better adherence to WeChat self-monitoring. The community-based population displayed good adherence when using WeChat self-monitoring.
ClinicalTrials.gov NCT02618265; https://clinicaltrials.gov/ct2/show/NCT02618265.
真实世界的研究表明，坚持用药对于保证药物疗效至关重要。很少有研究测试过基于微信的手机改善服务在出院脑卒中患者二级预防随访中的可行性和疗效。
我们评估了一种基于微信的缺血性脑卒中二级预防改善服务，旨在提高出院患者的治疗依从性。该服务专注于发送用药、血压记录和血糖记录的提醒，同时记录用药情况。我们比较了微信自我监测和传统监测的终点事件发生率。
采用队列研究确定了一种基于微信的、由医生辅助的改善服务和随访自我监测平台在缺血性脑卒中二级预防中的可行性。该平台由北京大学第三医院基于信息-动机-行为技能模型开发。总体依从率计算为上传验证的用药剂量比例。比较传统预防监测和微信自我监测的缺血终点事件发生率和药物不依从率。总结影响依从性的因素。
微信自我监测组的 1 年随访事件发生率为 11.9%（12/101），低于传统组（21/157，13.4%）。与传统组相比，微信组的风险比为 0.983（95%CI 0.895-1.080），差异无统计学意义。微信监测组的 1 年药物不依从率（3/101，3.0%）倾向于低于传统组（11/157，7.0%；χ=1.9，df=1，P=0.16）。平台登记参与者中，89.7%（210/234：167 名医院和 43 名社区参与者）坚持在微信中输入信息 8-96 周。平均依从时间为 16.54（SD 0.80，范围 2-24）个月。平均每月减少依从性 4 人（1.1%）。作为社区人群的一员是 2 年随访时良好依从性的影响因素（OR 2.373，95%CI 1.019-5.527，P=0.045），而短暂性脑缺血发作是 2 年随访时不良依从性的影响因素（OR 0.122，95%CI 0.016-0.940，P=0.04）。
与传统监测相比，微信自我监测显示出增加药物依从性和降低缺血终点事件发生率的趋势。然而，结果存在上限效应，并且使用的样本量相对较小。男性参与者对微信自我监测的依从性较好。社区人群使用微信自我监测时依从性良好。
ClinicalTrials.gov NCT02618265；https://clinicaltrials.gov/ct2/show/NCT02618265。
