Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Oct 9, 2019
Date Accepted: Feb 1, 2020
A highly tailored text and voice messaging intervention to improve medication adherence in patients with hypertension and/or type 2 diabetes in UK primary care setting. A feasibility randomised controlled trial.
ABSTRACT
Background:
The feasibility and potential efficacy of a highly tailored digital intervention to support medication adherence as an adjunct to primary care setting has not been evaluated.
Objective:
This trial aimed to assess the feasibility, fidelity, behavioural and clinical outcomes of a highly tailored digital intervention to support medication adherence in patients with hypertension and/or type 2 diabetes.
Methods:
This was a multi-centre, individually randomised controlled trial of two parallel groups: intervention group received a highly tailored text message and interactive voice response intervention for 12 weeks, and control group received usual care. Medication adherence was measured using self-reports and assessor-blinded practice records of repeat prescription. Systolic blood pressure, glucose levels, and quality of life were assessed by nurses blinded to group allocation during practice visits at 12 weeks follow up. We also examined quality of life. Intervention group provided data about intervention uptake, engagement, acceptability, satisfaction and mechanisms of action.
Results:
A total of 135 non-adherent patients (46% female, 64.3% between 50-79 years old) were randomly allocated to intervention (n=79) or control group (n=56), of whom 12% were lost at follow up. Medication adherence was significantly improved at the intervention group compared to the control group (t=2.27, P=0.02). Systolic blood pressure was 0.6 mmHg (95%CI -7.423 to 6.301) and HbA1c was 4.5 mmol/mol (95%CI -13.099 to 4.710) lower at the intervention group compared to the control group. The intervention had 100% fidelity, 61% engagement and 75% satisfaction scores.
Conclusions:
Our trial showed that among medication non-adherent patients with either or both hypertension and type 2 diabetes, a highly tailored digital intervention was feasible and effective and had high fidelity and good engagement scores. Future research is needed to evaluate the intervention effectiveness and cost-effectiveness in primary care.
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