Personalized Patient Data and Behavioral Nudges to Improve Adherence to Chronic Cardiovascular Medications
Study Details
Study Description
Brief Summary
The study plans to learn if sending different text messages, serving as reminders or encouragement, may help patients take their medication more often if they have had trouble keeping up with their medicines.
Condition or Disease | Intervention/Treatment | Phase |
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N/A |
Detailed Description
Background: Up to fifty percent of patients do not take their cardiovascular medications as prescribed resulting in increased morbidity, mortality, and healthcare costs. Mobile and digital technologies for health promotion and disease self-management offer an intriguing and as of yet untested opportunity to adapt behavioral 'nudges' using ubiquitous cell phone technology to facilitate medication adherence.
Objectives: Aim 1: Conduct a pragmatic patient-level randomized intervention across three health care systems (HCS) to improve adherence to chronic CV medications. The primary outcome will be medication adherence defined by the proportion of days covered (PDC) using pharmacy refill data. Secondary outcomes will include intermediate clinical measures (e.g., BP control), CV clinical events (e.g., hospitalizations), healthcare utilization, and costs. Aim 2: Evaluate the intervention using a mixed methods approach and applying the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework. In addition, assess the context and implementation processes to inform local tailoring, adaptations and modifications, and eventual expansion of the intervention within the 3 HCS more broadly and nationally.
Setting: The study will be conducted within three HCS in metro Denver: VA Eastern Colorado Health Care System (VA), Denver Health and Hospital Authority, and UCHealth.
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
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No Intervention: Usual Care This group will not receive an intervention. We have included a usual care group to demonstrate the impact of the text messaging interventions above and beyond usual care given that many prior medication adherence interventions have demonstrated small to negligible effects. |
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Experimental: Generic Nudge A generic reminder text will be delivered to patients to refill their medication at days 1, 3, 5, 7 and 10 after they been labeled as non-adherent. |
Behavioral: Nudge
Interventions will include a variety of text messages aimed at improving medication adherence.
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Experimental: Optimized nudge An optimized nudge text will be delivered to patients to remind them to refill their medications at days 1, 3, 5, 7 and 10 after they have been labeled as non-adherent. |
Behavioral: Nudge
Interventions will include a variety of text messages aimed at improving medication adherence.
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Experimental: Optimized nudge plus AI Chat Bot An optimized nudge text will be delivered to patients to remind them to refill their medications at days 1 and 3 after they have been labeled as non-adherent. If the patient has not filled their medication on days 5 and 7, in addition to receiving an optimized nudge text, an AI will conduct interactive chat via a chat bot to assess barriers filling the medication as described in Aim 1 above. If they still have not filled the medication, they will receive another message on day 10. |
Behavioral: Nudge
Interventions will include a variety of text messages aimed at improving medication adherence.
|
Outcome Measures
Primary Outcome Measures
- Medication adherence [Up to 12 months after intervention]
The primary outcome will be medication adherence defined by the proportion of days covered (PDC) using pharmacy refill data.
Secondary Outcome Measures
- Blood pressure [Up to 12 months after intervention]
Blood pressure (systolic and diastolic) measurements are defined by the last recorded measurement in months 10-12 following study enrollment.
- Low-density lipoproteins (LDL) [Up to 12 months after intervention]
LDL measurements are defined by the last recorded measurement in months 10-12 following study enrollment.
- Hemoglobin A1c [Up to 12 months after intervention]
Hemoglobin A1c measurements are defined by the last recorded measurement in months 10-12 following study enrollment.
- Hospitalizations rate (Cardiovascular clinical events) [Up to 12 months after intervention]
Hospitalizations due to hypertension emergency, myocardial infarction (MI), stroke, heart failure, hyperglycemia, and atrial fibrillation, are identified by an inpatient stay in the year following study enrollment.
- Emergency Department admission rates (Cardiovascular clinical events) [Up to 12 months after intervention]
Emergency Department admissions due to hypertension emergency, myocardial infarction (MI), stroke, heart failure, hyperglycemia, and atrial fibrillation are identified by an event in the year following study enrollment.
- Percutaneous coronary intervention (PCI) rates, (Cardiovascular clinical events) [Up to 12 months after intervention]
PCI are identified by a procedure in the year following study enrollment.
- Coronary artery bypass graft (CABG) rates, (Cardiovascular clinical events) [Up to 12 months after intervention]
CABG are identified by a procedure in the year following study enrollment.
- Cardioversion rates (Cardiovascular clinical events) [Up to 12 months after intervention]
Cardioversion are identified by a procedure in the year following study enrollment.
- All-cause hospitalizations (Hospitalizations) [Up to 12 months after intervention]
All-cause hospitalizations are identified by an inpatient stay in the year following study enrollment
- All-cause Emergency Department admissions (Hospitalizations) [Up to 12 months after intervention]
All-cause Emergency Department admissions are identified by an event in the year following study enrollment
- Implementation costs (Costs) [Up to 12 months after intervention]
The total cost of implementing each intervention to inform the resource use and investment required of each intervention.
- Healthcare utilization costs (Costs) [Up to 12 months after intervention]
Healthcare costs and cost offsets associated with the intervention to inform if there were reductions in healthcare utilization.
Eligibility Criteria
Criteria
Inclusion Criteria:
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Patients with the following cardiovascular conditions and respective medication classes:
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Hypertension (Beta-blockers [B-blockers)], Calcium Channel Blocker [CCB], Angiotensin converting enzyme inhibitors (ACEi), Angiotensin Receptor Blockers [ARB], or Thiazide diuretic)
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Hyperlipidemia (HMG CoA reductase inhibitor [Statins])
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Diabetes (Alpha-glucosidase inhibitors, Biguanides, DPP-4 inhibitors, Sodium glucose transport inhibitor, Meglitinides, Sulfonylureas, Thiazolidinediones, or statins Coronary artery disease P2Y12 inhibitor [Clopidogrel, Ticagrelor, Prasugrel, Ticlopidine], B-blockers, ACEi or ARB or statins)
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Atrial fibrillation (Direct oral anticoagulants, B-blockers, CCB)
Exclusion Criteria:
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Patients who do not have a mailing address listed in EHR;
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Patients who do not have a landline or cellphone listed in EHR;
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Currently pregnant if denoted in the EHR at the time of the data pull;
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Patients with a mailing address outside of the state of Colorado;
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Patients that do not speak either English or Spanish.
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
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1 | UCHealth | Aurora | Colorado | United States | 80045 |
2 | University of Colorado Denver | Aurora | Colorado | United States | 80045 |
3 | VA Eastern Colorado Health Care System | Aurora | Colorado | United States | 80045 |
4 | Denver Health and Hospital Authority | Denver | Colorado | United States | 80204 |
Sponsors and Collaborators
- University of Colorado, Denver
- National Heart, Lung, and Blood Institute (NHLBI)
Investigators
- Principal Investigator: Michael Ho, MD, PhD, University of Colorado, Denver
- Principal Investigator: Sheana Bull, PhD, MPH, University of Colorado, Denver
Study Documents (Full-Text)
None provided.More Information
Additional Information:
Publications
- Brown MT, Bussell JK. Medication adherence: WHO cares? Mayo Clin Proc. 2011 Apr;86(4):304-14. doi: 10.4065/mcp.2010.0575. Epub 2011 Mar 9.
- de Jongh T, Gurol-Urganci I, Vodopivec-Jamsek V, Car J, Atun R. Mobile phone messaging for facilitating self-management of long-term illnesses. Cochrane Database Syst Rev. 2012 Dec 12;12:CD007459. doi: 10.1002/14651858.CD007459.pub2. Review.
- Gurol-Urganci I, de Jongh T, Vodopivec-Jamsek V, Atun R, Car J. Mobile phone messaging reminders for attendance at healthcare appointments. Cochrane Database Syst Rev. 2013 Dec 5;(12):CD007458. doi: 10.1002/14651858.CD007458.pub3. Review.
- Ho PM, Spertus JA, Masoudi FA, Reid KJ, Peterson ED, Magid DJ, Krumholz HM, Rumsfeld JS. Impact of medication therapy discontinuation on mortality after myocardial infarction. Arch Intern Med. 2006 Sep 25;166(17):1842-7.
- Jackevicius CA, Li P, Tu JV. Prevalence, predictors, and outcomes of primary nonadherence after acute myocardial infarction. Circulation. 2008 Feb 26;117(8):1028-36. doi: 10.1161/CIRCULATIONAHA.107.706820.
- Lee JK, Grace KA, Taylor AJ. Effect of a pharmacy care program on medication adherence and persistence, blood pressure, and low-density lipoprotein cholesterol: a randomized controlled trial. JAMA. 2006 Dec 6;296(21):2563-71. Epub 2006 Nov 13.
- Lu CY, Ross-Degnan D, Soumerai SB, Pearson SA. Interventions designed to improve the quality and efficiency of medication use in managed care: a critical review of the literature - 2001-2007. BMC Health Serv Res. 2008 Apr 7;8:75. doi: 10.1186/1472-6963-8-75.
- Murray MD, Young J, Hoke S, Tu W, Weiner M, Morrow D, Stroupe KT, Wu J, Clark D, Smith F, Gradus-Pizlo I, Weinberger M, Brater DC. Pharmacist intervention to improve medication adherence in heart failure: a randomized trial. Ann Intern Med. 2007 May 15;146(10):714-25.
- Peterson PN, Campagna EJ, Maravi M, Allen LA, Bull S, Steiner JF, Havranek EP, Dickinson LM, Masoudi FA. Acculturation and outcomes among patients with heart failure. Circ Heart Fail. 2012 Mar 1;5(2):160-6. doi: 10.1161/CIRCHEARTFAILURE.111.963561. Epub 2012 Jan 13.
- Rasmussen JN, Chong A, Alter DA. Relationship between adherence to evidence-based pharmacotherapy and long-term mortality after acute myocardial infarction. JAMA. 2007 Jan 10;297(2):177-86.
- Spertus JA, Kettelkamp R, Vance C, Decker C, Jones PG, Rumsfeld JS, Messenger JC, Khanal S, Peterson ED, Bach RG, Krumholz HM, Cohen DJ. Prevalence, predictors, and outcomes of premature discontinuation of thienopyridine therapy after drug-eluting stent placement: results from the PREMIER registry. Circulation. 2006 Jun 20;113(24):2803-9. Epub 2006 Jun 12.
- Vodopivec-Jamsek V, de Jongh T, Gurol-Urganci I, Atun R, Car J. Mobile phone messaging for preventive health care. Cochrane Database Syst Rev. 2012 Dec 12;12:CD007457. doi: 10.1002/14651858.CD007457.pub2. Review.
- Volpp KG, Loewenstein G, Troxel AB, Doshi J, Price M, Laskin M, Kimmel SE. A test of financial incentives to improve warfarin adherence. BMC Health Serv Res. 2008 Dec 23;8:272. doi: 10.1186/1472-6963-8-272.
- Wei L, Flynn R, Murray GD, MacDonald TM. Use and adherence to beta-blockers for secondary prevention of myocardial infarction: who is not getting the treatment? Pharmacoepidemiol Drug Saf. 2004 Nov;13(11):761-6.
- Wei L, Wang J, Thompson P, Wong S, Struthers AD, MacDonald TM. Adherence to statin treatment and readmission of patients after myocardial infarction: a six year follow up study. Heart. 2002 Sep;88(3):229-33.
- 18-2779
- UH3HL144163