Dataset Information

Electronic Pill Bottles or Bidirectional Text Messaging to Improve Hypertension Medication Adherence (Way 2 Text): a Randomized Clinical Trial.

ABSTRACT: BACKGROUND:Poor medication adherence contributes to inadequate control of hypertension. However, the value of adherence monitoring is unknown. OBJECTIVE:To evaluate the impact of monitoring adherence with electronic pill bottles or bidirectional text messaging on improving hypertension control. DESIGN:Three-arm pragmatic randomized controlled trial. PATIENTS:One hundred forty-nine primary care patients aged 18-75 with hypertension and text messaging capabilities who were seen at least twice in the prior 12 months with at least two out-of-range blood pressure (BP) measurements, including the most recent visit. INTERVENTIONS:Patients were randomized in a 1:2:2 ratio to receive (1) usual care, (2) electronic pill bottles for medication adherence monitoring (pill bottle), and (3) bidirectional text messaging for medication adherence monitoring (bidirectional text). MAIN MEASURES:Change in systolic BP during the final 4-month visit compared with baseline. KEY RESULTS:At the 4-month follow-up visit, mean (SD) change values in systolic blood pressure were -?4.7 (23.4) mmHg in usual care, -?4.3 (21.5) mmHg in the pill bottle arm, and -?4.6 (19.8) mmHg in the text arm. There was no significant change in systolic blood pressure between control and the pill bottle arm (p?=?0.94) or the text messaging arm (p?=?1.00), and the two intervention arms did not differ from each other (p?=?0.93). CONCLUSIONS:Despite good measured adherence, neither feedback with electronic pill bottles nor bidirectional text messaging about medication adherence improved blood pressure control. Adherence to prescribed medications was not improved enough to affect BP control or it was not the primary driver of poor control. TRIAL REGISTRATION:clinicaltrials.gov (NCT02778542).

SUBMITTER: Mehta SJ

PROVIDER: S-EPMC6848522 | biostudies-literature | 2019 Nov

REPOSITORIES: biostudies-literature

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Electronic Pill Bottles or Bidirectional Text Messaging to Improve Hypertension Medication Adherence (Way 2 Text): a Randomized Clinical Trial.

Mehta Shivan J SJ Volpp Kevin G KG Troxel Andrea B AB Day Susan C SC Lim Raymond R Marcus Noora N Norton Laurie L Anderson Sophia S Asch David A DA

Journal of general internal medicine 20190808 11

<h4>Background</h4>Poor medication adherence contributes to inadequate control of hypertension. However, the value of adherence monitoring is unknown.<h4>Objective</h4>To evaluate the impact of monitoring adherence with electronic pill bottles or bidirectional text messaging on improving hypertension control.<h4>Design</h4>Three-arm pragmatic randomized controlled trial.<h4>Patients</h4>One hundred forty-nine primary care patients aged 18-75 with hypertension and text messaging capabilities who ...[more]

PMID: 31396815

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Project description:BackgroundHypertension (HTN) is a major public health concern in the United States, with almost 78 million Americans age 20 years and over suffering from the condition. Moreover, HTN is a key risk factor for health disease and stroke. African Americans disproportionately shoulder the burdens of HTN, with greater prevalence, disease severity, earlier onset, and more HTN-related complications than age-matched whites. Medication adherence for the treatment of HTN is poor, with estimates indicating that only about half of hypertensive patients are adherent to prescribed medication regimens. Although no single intervention for improving medication adherence has emerged as superior to others, text message medication reminders have the potential to help improve medication adherence in African Americans with uncontrolled HTN as mobile phone adoption is very high in this population.ObjectiveThe purpose of this two-phased study was to develop (Phase I) and test in a randomized controlled trial (RCT) (Phase II) a text message system, BPMED, to improve the quality of medication management through increasing medication adherence in African Americans with uncontrolled HTN.MethodsIn Phase I, we recruited 16 target end-users from a primary care clinic, to assist in the development of BPMED through participating in one of three focus groups. Focus groups sought to gain patient perspectives on HTN, medication adherence, mobile phone use, and the use of text messaging to support medication adherence. Potential intervention designs were presented to participants, and feedback on the designs was solicited. In Phase II, we conducted two pilot RCTs to determine the feasibility, acceptability, and preliminary efficacy of BPMED in primary care and emergency department settings. Both pilot studies recruited approximately 60 participants, who were randomized equally between usual care and the BPMED intervention.ResultsAlthough data collection is now complete, data analysis from the two pilot RCTs is still ongoing and results are expected in 2015.ConclusionsThis study was designed to determine preliminary feasibility and acceptability of our approach among African Americans with uncontrolled HTN in primary care and emergency department settings. Results from these studies are of great interest as little work has been done to document the use of text message medication reminders to improve HTN-related outcomes, particularly within underserved urban minorities.Trial registrationClinicaltrials.gov NCT01465217; https://clinicaltrials.gov/ct2/show/NCT01465217 (Archived by WebCite at http://www.webcitation.org/6V0tto0lZ).

Project description:BackgroundFree-text communication between patients and providers plays an increasing role in chronic disease management, through platforms varying from traditional health care portals to novel mobile messaging apps. These text data are rich resources for clinical purposes, but their sheer volume render them difficult to manage. Even automated approaches, such as natural language processing, require labor-intensive manual classification for developing training data sets. Automated approaches to organizing free-text data are necessary to facilitate use of free-text communication for clinical care.ObjectiveThe aim of this study was to apply unsupervised learning approaches to (1) understand the types of topics discussed and (2) learn medication-related intents from messages sent between patients and providers through a bidirectional text messaging system for managing participant blood pressure (BP).MethodsThis study was a secondary analysis of deidentified messages from a remote, mobile, text-based employee hypertension management program at an academic institution. We trained a latent Dirichlet allocation (LDA) model for each message type (ie, inbound patient messages and outbound provider messages) and identified the distribution of major topics and significant topics (probability >.20) across message types. Next, we annotated all medication-related messages with a single medication intent. Then, we trained a second medication-specific LDA (medLDA) model to assess how well the unsupervised method could identify more fine-grained medication intents. We encoded each medication message with n-grams (n=1-3 words) using spaCy, clinical named entities using Stanza, and medication categories using MedEx; we then applied chi-square feature selection to learn the most informative features associated with each medication intent.ResultsIn total, 253 participants and 5 providers engaged in the program, generating 12,131 total messages: 46.90% (n=5689) patient messages and 53.10% (n=6442) provider messages. Most patient messages corresponded to BP reporting, BP encouragement, and appointment scheduling; most provider messages corresponded to BP reporting, medication adherence, and confirmatory statements. Most patient and provider messages contained 1 topic and few contained more than 3 topics identified using LDA. In total, 534 medication messages were annotated with a single medication intent. Of these, 282 (52.8%) were patient medication messages: most referred to the medication request intent (n=134, 47.5%). Most of the 252 (47.2%) provider medication messages referred to the medication question intent (n=173, 68.7%). Although the medLDA model could identify a majority intent within each topic, it could not distinguish medication intents with low prevalence within patient or provider messages. Richer feature engineering identified informative lexical-semantic patterns associated with each medication intent class.ConclusionsLDA can be an effective method for generating subgroups of messages with similar term usage and facilitating the review of topics to inform annotations. However, few training cases and shared vocabulary between intents precludes the use of LDA for fully automated, deep, medication intent classification.International registered report identifier (irrid)RR2-10.1101/2021.12.23.21268061.

Project description:BackgroundHypertension (HTN) is an important problem in the United States, with an estimated 78 million Americans aged 20 years and older suffering from this condition. Health disparities related to HTN are common in the United States, with African Americans suffering from greater prevalence of the condition than whites, as well as greater severity, earlier onset, and more complications. Medication adherence is an important component of HTN management, but adherence is often poor, and simply forgetting to take medications is often cited as a reason. Mobile health (mHealth) strategies have the potential to be a low-cost and effective method for improving medication adherence that also has broad reach.ObjectiveOur goal was to determine the feasibility, acceptability, and preliminary clinical effectiveness of BPMED, an intervention designed to improve medication adherence among African Americans with uncontrolled HTN, through fully automated text messaging support.MethodsWe conducted two parallel, unblinded randomized controlled pilot trials with African-American patients who had uncontrolled HTN, recruited from primary care and emergency department (ED) settings. In each trial, participants were randomized to receive either usual care or the BPMED intervention for one month. Data were collected in-person at baseline and one-month follow-up, assessing the effect on medication adherence, systolic and diastolic blood pressure (SBP and DBP), medication adherence self-efficacy, and participant satisfaction. Data for both randomized controlled pilot trials were analyzed separately and combined.ResultsA total of 58 primary care and 65 ED participants were recruited with retention rates of 91% (53/58) and 88% (57/65), respectively. BPMED participants consistently showed numerically greater, yet nonsignificant, improvements in measures of medication adherence (mean change 0.9, SD 2.0 vs mean change 0.5, SD 1.5, P=.26), SBP (mean change -12.6, SD 24.0 vs mean change -11.3, SD 25.5 mm Hg, P=.78), and DBP (mean change -4.9, SD 13.1 mm Hg vs mean change -3.3, SD 14.3 mm Hg, P=.54). Control and BPMED participants had slight improvements to medication adherence self-efficacy (mean change 0.8, SD 9.8 vs mean change 0.7, SD 7.0) with no significant differences found between groups (P=.92). On linear regression analysis, baseline SBP was the only predictor of SBP change; participants with higher SBP at enrollment exhibited significantly greater improvements at one-month follow-up (β=-0.63, P<.001). In total, 94% (51/54) of BPMED participants agreed/strongly agreed that they were satisfied with the program, regardless of pilot setting.ConclusionsUse of text message reminders to improve medication adherence is a feasible and acceptable approach among African Americans with uncontrolled HTN. Although differences in actual medication adherence and blood pressure between BPMED and usual care controls were not significant, patterns of improvement in the BPMED condition suggest that text message medication reminders may have an effect and fully powered investigations with longer-term follow-up are warranted.Trial registrationClinicaltrials.gov NCT01465217; https://clinicaltrials.gov/ct2/show/NCT01465217 (Archived by WebCite at http://www.webcitation.org/6V0tto0lZ).

Project description:BackgroundeHealth interventions can help people change behavior (eg, quit smoking). Reminders sent via SMS text messaging or email may improve the adherence to web-based programs and increase the probability of successful behavior change; however, it is unclear whether their efficiency is affected by the modality of the communication channel.ObjectiveA 2-armed randomized control trial was conducted to compare the effect of providing reminders via SMS text messaging versus email on the adherence to an eHealth program for smoking cessation and on the probability to initiate a quit attempt.MethodsSmokers were recruited via an internet-based advertisement. A total of 591 participants who diverted from intended use of the program (ie, failed to log on to a session) were automatically randomized to the experimental (SMS text messaging reminder, n=304) or the active comparator (email reminder, n=287) group.ResultsUnexpectedly, we found that the mode of reminder delivery did not significantly affect either the adherence, namely the number of completed program sessions, with the SMS text messaging reminder group showing a mean of 4.30 (SD 3.24) and the email reminder group showing a mean of 4.36 (SD 3.27) (t586=0.197, P=.84, and Cohen d=0.016), or the outcome, namely the quit smoking attempt rate (34.2% in the SMS text messaging group vs 31.7% in the email group; χ21=0.4, P=.52). Secondary analyses showed that age, gender, and education had significant effects on program adherence and education on the outcome. Moreover, we found a significant interaction effect between the mode of reminder delivery and gender on program adherence, suggesting that the effectiveness of SMS text message reminders might be different for females and males. However, this particular finding should be treated with care as it was based on post hoc subgroup analysis.ConclusionsThis study indicates that the modality of user reminders to log on increased neither the program adherence nor the probability of quitting smoking. This suggests that program developers may save costs using emails instead of SMS text messaging reminders.Trial registrationClinicalTrials.gov NCT03276767; https://clinicaltrials.gov/ct2/show/ NCT03276767.

Project description:Interventions to support people with hypertension in attending clinics and taking their medication have potential to improve outcomes, but delivery on a wide scale and at low cost is challenging. Some trials evaluating clinical interventions using short message service (SMS) text-messaging systems have shown important outcomes, although evidence is limited. We have developed a novel SMS system integrated with clinical care for use by people with hypertension in a low-resource setting. We aim to test the efficacy of the system in improving blood pressure control and treatment adherence compared to usual care.The SMS Text-message Adherence suppoRt trial (StAR) is a pragmatic individually randomised three-arm parallel group trial in adults treated for hypertension at a single primary care centre in Cape Town, South Africa. The intervention is a structured programme of clinic appointment, medication pick-up reminders, medication adherence support and hypertension-related education delivered remotely using an automated system with either informational or interactive SMS text-messages. Usual care is supplemented by infrequent non-hypertension related SMS text-messages. Participants are 1:1:1 individually randomised, to usual care or to one of the two active interventions using minimisation to dynamically adjust for gender, age, baseline systolic blood pressure, years with hypertension, and previous clinic attendance. The primary outcome is the change in mean systolic blood pressure at 12-month follow-up from baseline measured with research staff blinded to trial allocation. Secondary outcomes include the proportion of patients with 80% or more of days medication available, proportion of participants achieving a systolic blood pressure less than 140 mmHg and a diastolic blood pressure less than 90 mmHg, hospital admissions, health status, retention in clinical care, satisfaction with treatment and care, and patient related quality of life. Anonymised demographic data are collected on non-participants.The StAR trial uses a novel, low cost system based on widely available mobile phone technology to deliver the SMS-based intervention, manage communication with patients, and measure clinically relevant outcomes. The results will inform implementation and wider use of mobile phone based interventions for health care delivery in a low-resource setting.NCT02019823.

Dataset Information

Electronic Pill Bottles or Bidirectional Text Messaging to Improve Hypertension Medication Adherence (Way 2 Text): a Randomized Clinical Trial.

Publications

Electronic Pill Bottles or Bidirectional Text Messaging to Improve Hypertension Medication Adherence (Way 2 Text): a Randomized Clinical Trial.

Similar Datasets

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