短信药物依从性提醒在两个机构大规模自动发送：测试推动系统：试点研究。
Text Message Medication Adherence Reminders Automated and Delivered at Scale Across Two Institutions: Testing the Nudge System: Pilot Study.
机构信息
University of Colorado Anschutz Medical Campus, Aurora, CO (P.L., G.K.G., P.P., L.A.A., A.K., J.W., L.S., P.M.H., S.B.).
Veteran Affairs Eastern Colorado Health Care System, Aurora, CO (T.J.G., G.K.G., P.M.H.).
出版信息
Circ Cardiovasc Qual Outcomes. 2021 May;14(5):e007015. doi: 10.1161/CIRCOUTCOMES.120.007015. Epub 2021 May 17.
BACKGROUND
Medication refill behavior in patients with cardiovascular diseases is suboptimal. Brief behavioral interventions called Nudges may impact medication refill behavior and can be delivered at scale to patients using text messaging.
METHODS
Patients who were prescribed and filled at least one medication for hypertension, hyperlipidemia, diabetes, atrial fibrillation, and coronary artery disease were identified for the pilot study. Patients eligible for the pilot (N=400) were enrolled with an opportunity to opt out. In phase I of the pilot, we tested text message delivery to 60 patients. In phase II, we tested intervention feasibility by identifying those with refill gap of ≥7 days and randomized them to intervention or control arms. Patients were texted Nudges and assessed whether they refilled their medications.
RESULTS
Of 400 patients sent study invitations, 56 (14%) opted out. In phase I, we successfully delivered text messages to 58 of 60 patients and captured patient responses via text. In phase II, 207 of 286 (72.4%) patients had a medication gap ≥7 days for one or more cardiovascular medications and were randomized to intervention or control. Enrolled patients averaged 61.7 years old, were primarily male (69.1%) and White (72.5%) with hypertension being the most prevalent qualifying condition (78.7%). There was a trend towards intervention patients being more likely to refill at least 1 gapping medication (30.6% versus 18.0%; =0.12) and all gapping medications (17.8% versus 10.0%; =0.27).
CONCLUSIONS
It is possible to set up automated processes within health care delivery systems to identify patients with gaps in medication adherence and send Nudges to facilitate medication refills. Text message Nudges could potentially be a feasible and effective method to facilitate medication refills. A large multi-site randomized trial to determine the impact of text-based Nudges on overall CVD morbidity and mortality is now underway to explore this further. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03973931.
背景
心血管疾病患者的药物续配行为并不理想。所谓的“推动”（Nudge）是一种简短的行为干预措施，它可以通过短信的方式大规模地应用于患者，从而影响他们的药物续配行为。
方法
本研究纳入了至少服用一种降压药、降脂药、降糖药、抗心律失常药和抗冠状动脉粥样硬化药的高血压、高血脂、糖尿病、心房颤动和冠心病患者。符合入组条件（N=400）的患者被邀请参加试验，同时也给予了他们退出试验的机会。在试点研究的第一阶段，我们对 60 名患者进行了短信发送测试。在第二阶段，我们通过识别那些药物续配间隔≥7 天的患者，并将他们随机分配到干预组或对照组，以此来测试干预措施的可行性。我们向患者发送了“推动”短信，并评估他们是否续配了药物。
结果
在 400 名收到研究邀请的患者中，有 56 名（14%）选择退出。在第一阶段，我们成功地向 60 名患者中的 58 名发送了短信，并通过短信获得了患者的回复。在第二阶段，286 名患者中有 207 名（72.4%）的一种或多种心血管药物的续配间隔≥7 天，他们被随机分配到干预组或对照组。入组患者的平均年龄为 61.7 岁，主要为男性（69.1%）和白人（72.5%），其中高血压是最常见的合格疾病（78.7%）。干预组患者更有可能至少续配一种漏配药物（30.6%比 18.0%；=0.12）和所有漏配药物（17.8%比 10.0%；=0.27），这一趋势具有统计学意义。
结论
在医疗服务提供系统中建立自动化流程，以识别药物依从性存在差距的患者，并发送“推动”短信来促进药物续配是可行的。短信“推动”可能是促进药物续配的一种可行且有效的方法。目前正在进行一项大型多中心随机试验，以进一步探讨基于短信的“推动”对整体心血管疾病发病率和死亡率的影响。注册：网址：https://www.clinicaltrials.gov；唯一标识符：NCT03973931。
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