随机试点试验：表扬短信对改善青少年和青年肝移植患者药物依从性的影响

Randomized pilot trial of praise text messages to improve medication adherence among adolescents and young adults with liver transplants.

机构信息

Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA.

USC University Center for Excellence in Developmental Disabilities, Children's Hospital Los Angeles, Los Angeles, California, USA.

出版信息

Pediatr Transplant. 2022 Nov;26(7):e14361. doi: 10.1111/petr.14361. Epub 2022 Jul 19.

DOI:10.1111/petr.14361

PMID:35854423

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9560958/

Abstract

BACKGROUND

AYA who have undergone liver transplantations often struggle to adhere to their post-transplant immunosuppressant medications, which can lead to serious health complications. The objective of this pilot study is to examine the acceptability and feasibility of a brief mobile health (mHealth) intervention and its impact on medication adherence among AYA liver transplant recipients.

METHODS

Thirty-five AYAs (13-21 years old) were randomized to either (1) receive praise text messages whenever laboratory results indicated immunosuppressant medications within the expected range or (2) usual care. Motivation for adherence and adherence were assessed via self-report, and a MLVI was calculated based on values abstracted from the electronic health record.

RESULTS

Multilevel, multivariate models showed significant associations between group assignment and some self-reported motivation and adherence outcomes but not MLVI. Specifically, AYA receiving the praise text messages were significantly more likely to report taking their prescribed doses (OR = 2.49, p = .03), taking their medicine according to the directions (OR = 2.39, p = .04), and being highly confident in taking their medication (OR = 2.46, p = .04), compared with the usual services group. Qualitative responses indicated praise texts were mostly helpful but could be improved.

CONCLUSIONS

The results suggest texting patients about positive health indicators was acceptable and, with refinement, might promote AYA illness self-management.

摘要

背景

接受过肝移植的青少年往往难以坚持他们的移植后免疫抑制剂药物治疗，这可能导致严重的健康并发症。本初步研究的目的是检验简短移动医疗（mHealth）干预措施的可接受性和可行性，及其对青少年肝移植受者药物依从性的影响。

方法

35 名青少年（13-21 岁）被随机分配到以下两组之一：（1）每当实验室结果显示免疫抑制剂药物在预期范围内时，就会收到表扬短信；（2）常规护理。通过自我报告评估药物依从性的动机和依从性，并根据电子健康记录中提取的值计算 MLVI。

结果

多水平、多变量模型显示，组分配与一些自我报告的动机和依从性结果之间存在显著关联，但与 MLVI 无关。具体来说，与常规护理组相比，接受表扬短信的青少年更有可能报告他们按照医嘱服用了规定剂量的药物（OR=2.49，p=0.03）、按照指示服用了药物（OR=2.39，p=0.04），并且对服用药物非常有信心（OR=2.46，p=0.04）。