Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO.
Department of Pediatrics, National Jewish Health, Denver, CO.
Perm J. 2020 Nov;24:1-8. doi: 10.7812/TPP/19.199.
Refill reminders can help patients improve adherence to inhaled corticosteroid (ICS) therapy. However, little is known about patient preferences for reminder type or whether patients who express a preference differ from patients who do not.
To describe patient preferences for ICS prescription refill reminder type and to compare baseline ICS therapy adherence, measured as proportion of days covered (PDC) 1 year before initiating preference-based reminders, between patients who did and did not express a preference.
This substudy within a randomized multi-intervention study was conducted at Kaiser Permanente Colorado. Adults with asthma randomized to intervention were offered the opportunity to choose text, telephone, or email reminders. Patients who did and did not provide a preference were compared by baseline characteristics using log-binomial models.
MAIN OUTCOME MEASURE(S): The primary outcomes were reminder preference and type.
A total of 1497 of 4545 patients (32.9%) expressed a preference; 789 (52.7%) chose text. The adjusted relative risk (aRR) of not providing a preference increased with decreasing PDC (PDC of 0.50 to < 0.80: aRR, 1.14; 95% confidence interval [CI], 1.04-1.25; PDC < 0.5: aRR, 1.76; 95% CI, 1.59-1.95) compared with patients with a PDC of 0.80 or greater.
Among patients who expressed a preference, text reminders were preferred. Patients who expressed a preference had higher baseline adherence. Further research is needed to determine whether expressing a preference for a refill reminder type is itself associated with adherence. Given that offering the opportunity to choose a reminder type only engaged a subset of patients, further work is needed to understand how best to leverage technology-enabled communication outreach to help patients optimize adherence.
药物续方提醒有助于提高患者对吸入性皮质类固醇（ICS）疗法的依从性。但是，对于患者对提醒类型的偏好，以及表达偏好的患者和不表达偏好的患者是否存在差异，我们知之甚少。
描述患者对 ICS 处方续方提醒类型的偏好，并比较开始基于偏好的提醒前 1 年，记录的ICS 治疗依从性（以覆盖天数比例[PDC]衡量），比较表达和不表达偏好的患者之间的差异。
这是在 Kaiser Permanente Colorado 进行的一项随机多干预研究的子研究。接受干预的哮喘成年患者有机会选择短信、电话或电子邮件提醒。通过对数二项式模型比较表达和不表达偏好的患者之间的基线特征。
主要结局是提醒偏好和类型。
在 4545 名患者中，共有 1497 名（32.9%）表达了偏好；789 名（52.7%）选择了短信。与 PDC 为 0.80 或更高的患者相比，不表达偏好的调整后相对风险（aRR）随着 PDC 的降低而增加（PDC 为 0.50 至 <0.80：aRR，1.14；95%置信区间[CI]，1.04-1.25；PDC <0.5：aRR，1.76；95% CI，1.59-1.95）。
在表达偏好的患者中，短信提醒更受欢迎。表达偏好的患者基线依从性更高。需要进一步研究确定表达对续方提醒类型的偏好本身是否与依从性相关。由于仅提供选择提醒类型的机会只能吸引一部分患者，因此需要进一步研究如何更好地利用技术支持的沟通外出来帮助患者优化依从性。
