Behavioral Economics to improve Antihypertensive Therapy Adherence (BETA)

提高抗高血压治疗依从性的行为经济学（BETA）

基本信息

批准号：
10399491
负责人：
Joseph Ebinger
金额：
$ 22.37万
依托单位：
CEDARS-SINAI MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-05-01 至 2024-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10399491
关键词：
Adherence Adverse event American Antihypertensive Agents Attention Behavior Behavioral Blood Pressure Body Weight decreased Cardiovascular system Caring Cessation of life Clinic Clinical Pharmacists Clinical Trials Cognitive Community Health Aides Complement Control Groups Cues Data Data Collection Drug Prescriptions Eating Education Effectiveness of Interventions Event Exercise Fatigue Feedback Focus Groups Future Health Expenditures Heart failure Hypertension Incentives Increased frequency of micturition Intervention Libido Life Style Modification Link Measures Medical Motivation Myocardial Infarction Nurses Outcome Outcome Study Participant Patients Pharmaceutical Preparations Pharmacists Phase Physicians Population Preparation Provider Public Health Randomized Controlled Trials Reaction Research Resources Rewards Risk Risk Factors Stroke Surveys Testing Text Messaging Time Toothbrushing United States Work acceptability and feasibility base behavioral economics blood pressure control blood pressure elevation blood pressure reduction cardiovascular disorder risk cardiovascular risk factor clinical practice cost dietary salt effective intervention financial incentive group intervention hypertension control hypertensive improved insight intrinsic motivation medication compliance medication nonadherence novel novel strategies phase 2 testing pill primary outcome relative effectiveness response scale up secondary outcome side effect therapy adherence therapy design therapy development

项目摘要

PROJECT SUMMARY Hypertension is one of the most prevalent cardiovascular disease risk factors, with over 45% of the United States population having elevated blood pressure. Decades of research have demonstrated that controlling blood pressure can reduce the risk of serious adverse cardiovascular events including stroke, myocardial infarction, and heart failure. A key component of successfully obtaining control of hypertension is the use of medications to lower blood pressure. Unfortunately, more than 50% of Americans demonstrate medication non-adherence, a statistic that directly contributes to suboptimal blood pressure control and, therefore, excess preventable cardiovascular events. Strong data indicates that linking the taking of medications to daily routines (‘anchoring’) increases adherence, however, existing interventions built on this information have failed to create successful, long term improvements in medication adherence. This study aims to leverage behavioral economic insights to improve medication adherence to antihypertensive medications. Specifically, we propose to complement linking medication taking to a daily routine with two added components to make it easier for participants to stick to their anchoring plan: increasing information salience through frequent text messages and providing intermittent rewards for pill-taking according to the anchoring plan. This study will be implemented in a pilot randomized controlled trial (RCT) in a high-volume clinical practice to establish feasibility, acceptability, and preliminary efficacy. The specific aims include 1) a formative phase to develop the intervention and evaluate its feasibility and acceptability via focus groups with key stakeholders; 2) a RCT of 60 hypertensive patients in which a control group (n=20) is provided education on anchoring medication taking to a daily routine, and two intervention groups, one (n=20) who receives anchoring education and daily text message reminders and another (n=20) which receives anchoring education, text messages, and financial incentives for adherence in accordance with their anchoring plan; and 3) data collection in preparation for a future R01 application, including focus group discussions with key stakeholders (patients, providers [Physicians, Nurses, Advanced Care Practitioners, Pharmacists] and clinic staff) and exit focus groups with study participants regarding ways to improve the intervention. The main hypothesis is: the intervention is effective by anchoring pill-taking to an existing routine, tested by comparing the pooled (Message group + Incentive group) vs. the Control group. The secondary hypothesis is: adding incentives to the text messages is more effective for routinizing pill-taking (testing outcomes in the Incentive group vs. Message group). Outcomes from this study have the potential to greatly enhance our understanding of the barriers and facilitators of medication adherence among hypertensive patients and potentially provide evidence for a low-cost and scalable intervention to improve medication adherence in clinical practice.

项目摘要高血压是最普遍的心血管疾病危险因素之一，超过45％血压升高的人群。数十年的研究表明，控制血液压力可以降低严重不良心血管事件的风险，包括中风，心肌梗塞，和心力衰竭。成功获得高血压控制的关键组成部分是使用药物来降低血压。不幸的是，超过50％的美国人表现出药物不遵守，这是直接有助于次优血压控制的统计数据，因此超出了可预防的统计信息心血管事件。强数据表明，将药物服用与日常工作（“锚定”）联系起来但是，提高依从性，但是，基于此信息构建的现有干预措施未能创造成功，长期改善药物依从性。这项研究旨在利用行为经济洞察力改善药物遵守降压药。具体来说，我们建议补充链接用药每天都有两个添加的组件，以使参与者更容易坚持下去锚定计划：通过经常发短信并提供间歇性来提高信息显着性根据锚定计划奖励药丸。这项研究将在随机的飞行员中实施在高体积临床实践中对照试验（RCT），以建立可行性，可接受性和初步效率。具体目的包括1）开发干预措施并评估其可行性的形成阶段与关键利益相关者通过焦点小组的可接受性； 2）60名高血压患者的RCT在其中小组（n = 20）接受有关锚定药物进行日常工作的教育，两次干预一组（n = 20）接受锚定教育和每日短信提醒和另一个（n = 20）根据遵守教育，短信和经济激励措施的基础他们的锚定计划； 3）数据收集以准备未来的R01应用程序，包括焦点小组与主要利益相关者（患者，提供者[医师，护士，高级护理从业人员，药剂师]和诊所工作人员）和与研究参与者的退出焦点小组有关改善方法的方法干涉。主要假设是：干预措施是有效的通过比较合并的（消息组 +激励组）与对照组进行测试。次要假设是：在短信中添加激励措施更有效地定期服用药丸（测试结果在激励组与消息组中）。这项研究的结果有可能大大增强我们的了解高血压患者和有可能提供低成本且可扩展的干预措施以提高临床依从性的证据实践。