RESUMO
BACKGROUND: In a randomized controlled trial, lung transplant recipients (LTRs) using a mobile health intervention, Pocket Personal Assistant for Tracking Health (Pocket PATH), showed better adherence to the medical regimen than LTRs receiving usual care during the first year posttransplant. We examined whether these effects were maintained beyond the end of the trial and evaluated other potential risk factors for long-term nonadherence. METHODS: Adherence in 8 areas was evaluated at follow-up in separate LTR and family caregiver (collateral) assessments. Pocket PATH and usual care groups' nonadherence rates were compared; multivariable regression analyses then examined and controlled for other patient characteristics' associations with nonadherence. RESULTS: One hundred five LTRs (75% of survivors) were assessed (M = 3.9 years posttransplant, SD = 0.8). Nonadherence rates in the past month were 23%-81% for self-care and lifestyle requirements (diet, exercise, blood pressure monitoring, spirometry), 13%-23% for immunosuppressants and other medications, and 4% for tobacco use, with 31% clinic appointment nonadherence in the past year. In multivariable analysis, the Pocket PATH group showed lower risk of nonadherence to lifestyle requirements (diet/exercise) than the usual care group (P < 0.05). Younger age and factors during the first year posttransplant (acute graft rejection, chronically elevated anxiety, less time rehospitalized, nonadherence at the final randomized controlled trial assessment) were each associated with nonadherence in at least 1 area at follow-up (P < 0.05). CONCLUSIONS: Pocket PATH did not have sustained impact on most areas of the regimen, although we identified other risk factors for long-term nonadherence. Future work should explore strategies to facilitate sustained effects of mobile health interventions.
Assuntos
Rejeição de Enxerto/prevenção & controle , Imunossupressores/uso terapêutico , Transplante de Pulmão/efeitos adversos , Adesão à Medicação/estatística & dados numéricos , Aplicativos Móveis , Adulto , Fatores Etários , Idoso , Feminino , Seguimentos , Rejeição de Enxerto/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Sistemas de Alerta/instrumentação , Smartphone , Telemedicina/instrumentação , Telemedicina/métodos , Transplantados/estatística & dados numéricosRESUMO
Antihypertensive drug adherence (ADA) is a mainstay in blood pressure control. Education through mobile phone short message system (SMS) text messaging could improve ADA. The authors conducted a randomized study involving 314 patients with hypertension with <6 months of antihypertensive treatment from the Preventive Health Program of 12 different primary care centers in Santiago, Chile. Patients were randomly assigned to receive or not receive SMS related to ADA and healthy lifestyle. Adherence was assessed by the self-reported four-item scale Morisky-Green-Levine questionnaire at baseline and after 6 months of follow-up, with four of four positive questions classified as good adherence. Group comparison for adherence was performed by means of a logistic regression model, adjusting by baseline adherence, age older than 60 years, and sex. A total of 163 patients were randomized to receive and 151 to not receive SMS. After 6 months of follow-up, ADA in the non-SMS group decreased from 59.3% to 51.4% (P=.1). By contrast, adherence increased from 49% to 62.3% (P=.01) in the SMS group. Text messaging intervention improved ADA (risk ratio, 1.3; 95% confidence interval, 1.0-1.6 [P<.05]). At 6-month follow-up, text messaging resulted in an increase in reporting ADA in this hypertensive Latino population. This approach could become an effective tool to overcome poor medication adherence in the community.
Assuntos
Anti-Hipertensivos/uso terapêutico , Hipertensão , Adesão à Medicação , Sistemas de Alerta/instrumentação , Envio de Mensagens de Texto , Chile , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/psicologia , Masculino , Adesão à Medicação/psicologia , Adesão à Medicação/estatística & dados numéricos , Conduta do Tratamento Medicamentoso/organização & administração , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de SaúdeRESUMO
BACKGROUND: Tuberculosis (TB) is global health concern and a leading infectious cause of mortality. Reversing TB incidence and disease-related mortality is a major global health priority. Infectious disease mortality is directly linked to failure to adhere to treatments. Using technology to send reminders by short message services have been shown to improve treatment adherence. However, few studies have examined tuberculosis patient perceptions and attitudes towards using SMS technology to increase treatment adherence. In this study, we sought to investigate perceptions related to feasibility and acceptability of using text messaging to improve treatment adherence among adults who were receiving treatment for TB in Callao, Peru. METHODS: We conducted focus group qualitative interviews with current TB positive and non-contagious participants to understand the attitudes, perceptions, and feasibility of using short message service (SMS) reminders to improve TB treatment adherence. Subjects receiving care through the National TB Program were recruited through public health centers in Ventanilla, Callao, Peru. In four focus groups, we interviewed 16 patients. All interviews were recorded and transcribed verbatim. Thematic network analysis and codebook techniques were used to analyze data. RESULTS: Three major themes emerged from the data: limits on health literacy and information posed challenges to successful TB treatment adherence, treatment motivation at times facilitated adherence to TB treatment, and acceptability of SMS including positive perceptions of SMS to improve TB treatment adherence. The majority of patients shared considerations about how to effectively and confidentially administer an SMS intervention with TB positive participants. CONCLUSION: The overall perceptions of the use of SMS were positive and indicated that SMS technology may be an efficient way to transmit motivational texts on treatment, health education information, and simple reminders to increase treatment adherence for low-income TB patients living in Peru.
Assuntos
Adesão à Medicação/psicologia , Sistemas de Alerta/instrumentação , Envio de Mensagens de Texto/estatística & dados numéricos , Tuberculose Pulmonar/psicologia , Adulto , Antituberculosos/uso terapêutico , Feminino , Grupos Focais , Humanos , Estudos Longitudinais , Masculino , Motivação , Satisfação do Paciente/estatística & dados numéricos , Peru , Projetos de Pesquisa , Tuberculose Pulmonar/tratamento farmacológicoRESUMO
OBJECTIVE: Nonattendance for appointments remains a challenge to health care managers and providers. The objective of this article is to present the results of a study on the impact of appointment reminders sent as short message service text messages to patients' cell phones on nonattendance rates at outpatient clinics in São Paulo, Brazil. DESIGN: Data were collected on scheduled appointments in four medical clinics using Clinic Manager or Clinic Web systems that can send automated messages to patients. Data on appointment attendance were collected from these systems. MEASUREMENTS: More than 29,000 appointments were scheduled between July 1, 2007, and May 31, 2008, and for 7890 of them a text message reminder was sent to the patient's cell phone. The rates of nonattendance were compared between those who were sent and those who were not sent a text message as an appointment reminder. RESULTS: The nonattendance reduction rates for appointments at the four outpatient clinics studied were 0.82% (p= .590), 3.55% (p= .009), 5.75% (p= .022), and 14.49% (p= < .001). CONCLUSION: The study results indicate that sending appointment reminders as text messages to patients' cell phones is an effective strategy to reduce nonattendance rates. When patients attend their appointments, the facility providing care and the patients receiving uninterrupted care benefit.