Shivan J Mehta1,2,3, Kevin G Volpp4,5,6,7, Andrea B Troxel8, Susan C Day4, Raymond Lim5,6, Noora Marcus5, Laurie Norton5, Sophia Anderson5, David A Asch4,5,6,7. 1. Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. shivan.mehta@uphs.upenn.edu. 2. Center for Health Incentives and Behavioral Economics, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA. shivan.mehta@uphs.upenn.edu. 3. Penn Medicine Center for Health Care Innovation, University of Pennsylvania, Philadelphia, PA, USA. shivan.mehta@uphs.upenn.edu. 4. Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. 5. Center for Health Incentives and Behavioral Economics, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA. 6. Penn Medicine Center for Health Care Innovation, University of Pennsylvania, Philadelphia, PA, USA. 7. Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, VA, USA. 8. Division of Biostatistics, Department of Population Health, NYU School of Medicine, New York, NY, USA.
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).
RCT Entities:
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).
Entities:
Keywords:
health behavior; hypertension; medication adherence; primary care
Authors: Paul A James; Suzanne Oparil; Barry L Carter; William C Cushman; Cheryl Dennison-Himmelfarb; Joel Handler; Daniel T Lackland; Michael L LeFevre; Thomas D MacKenzie; Olugbenga Ogedegbe; Sidney C Smith; Laura P Svetkey; Sandra J Taler; Raymond R Townsend; Jackson T Wright; Andrew S Narva; Eduardo Ortiz Journal: JAMA Date: 2014-02-05 Impact factor: 56.272
Authors: Marijn de Bruin; Harm J Hospers; Gerard J P van Breukelen; Gerjo Kok; William M Koevoets; Jan M Prins Journal: Health Psychol Date: 2010-07 Impact factor: 4.267
Authors: J Y Lee; J W Kusek; P G Greene; S Bernhard; K Norris; D Smith; B Wilkening; J T Wright Journal: Am J Hypertens Date: 1996-08 Impact factor: 2.689
Authors: K Matsumura; H Arima; M Tominaga; T Ohtsubo; T Sasaguri; K Fujii; M Fukuhara; K Uezono; Y Morinaga; Y Ohta; T Otonari; J Kawasaki; I Kato; T Tsuchihashi Journal: QJM Date: 2013-05-20
Authors: Kevin G Volpp; George Loewenstein; Andrea B Troxel; Jalpa Doshi; Maureen Price; Mitchell Laskin; Stephen E Kimmel Journal: BMC Health Serv Res Date: 2008-12-23 Impact factor: 2.655
Authors: Anahita Davoudi; Natalie S Lee; Krisda H Chaiyachati; Danielle L Mowery; Corey Chivers; Timothy Delaney; Elizabeth L Asch; Catherine Reitz; Shivan J Mehta Journal: J Med Internet Res Date: 2020-12-03 Impact factor: 5.428
Authors: Amy Hai Yan Chan; Holly Foot; Christina Joanne Pearce; Rob Horne; Juliet Michelle Foster; Jeff Harrison Journal: PLoS One Date: 2022-03-21 Impact factor: 3.240
Authors: Emily B Schroeder; Kelly R Moore; Spero M Manson; Megan A Baldwin; Glenn K Goodrich; Allen S Malone; Lisa E Pieper; Stanley Xu; Meredith P Fort; Linda Son-Stone; David Johnson; John F Steiner Journal: J Clin Hypertens (Greenwich) Date: 2020-06-09 Impact factor: 3.738
Authors: Peter P Reese; Iwan Barankay; Mary Putt; Louise B Russell; Jiali Yan; Jingsan Zhu; Qian Huang; George Loewenstein; Rolf Andersen; Heidi Testa; Adam S Mussell; David Pagnotti; Lisa E Wesby; Karen Hoffer; Kevin G Volpp Journal: JAMA Netw Open Date: 2021-10-01