Background:Medication refill behavior in patients with cardiovascular diseases is suboptimal. Brief behavioral interventions called Nudges may impact medication refill behavior and can be delivered at scale to patients using text messaging.Methods:Patients who were prescribed and filled at least one medication for hypertension, hyperlipidemia, diabetes, atrial fibrillation, and coronary artery disease were identified for the pilot study. Patients eligible for the pilot (N=400) were enrolled with an opportunity to opt out. In phase I of the pilot, we tested text message delivery to 60 patients. In phase II, we tested intervention feasibility by identifying those with refill gap of ≥7 days and randomized them to intervention or control arms. Patients were texted Nudges and assessed whether they refilled their medications.Results:Of 400 patients sent study invitations, 56 (14%) opted out. In phase I, we successfully delivered text messages to 58 of 60 patients and captured patient responses via text. In phase II, 207 of 286 (72.4%) patients had a medication gap ≥7 days for one or more cardiovascular medications and were randomized to intervention or control. Enrolled patients averaged 61.7 years old, were primarily male (69.1%) and White (72.5%) with hypertension being the most prevalent qualifying condition (78.7%). There was a trend towards intervention patients being more likely to refill at least 1 gapping medication (30.6% versus 18.0%; P=0.12) and all gapping medications (17.8% versus 10.0%; P=0.27).Conclusions:It is possible to set up automated processes within health care delivery systems to identify patients with gaps in medication adherence and send Nudges to facilitate medication refills. Text message Nudges could potentially be a feasible and effective method to facilitate medication refills. A large multi-site randomized trial to determine the impact of text-based Nudges on overall CVD morbidity and mortality is now underway to explore this further.Registration:URL: https://www.clinicaltrials.gov; Unique identifier: NCT03973931.

中文翻译：

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在两个机构之间大规模自动发送短信用药依从提醒：测试助推系统：试点研究


背景：心血管疾病患者的药物补充行为并不理想。被称为“助推”的简短行为干预措施可能会影响药物补充行为，并且可以通过短信大规模地向患者提供。方法：确定了服用至少一种治疗高血压、高脂血症、糖尿病、心房颤动和冠状动脉疾病药物的患者。进行试点研究。符合试点资格的患者 (N=400) 已登记并有机会选择退出。在试点的第一阶段，我们测试了向 60 名患者发送短信。在第二阶段，我们通过识别那些补充间隙≥7天的人并将他们随机分配到干预组或对照组来测试干预的可行性。患者收到短信“助推”，并评估他们是否重新服药。结果：在 400 名患者发出研究邀请中，56 名 (14%) 选择退出。在第一阶段，我们成功向 60 名患者中的 58 名发送短信，并通过短信捕获患者的反应。在 II 期中，286 名患者中的 207 名 (72.4%) 患者的一种或多种心血管药物治疗间隔≥7 天，并被随机分配至干预组或对照组。入组患者平均年龄 61.7 岁，主要是男性 (69.1%) 和白人 (72.5%)，其中高血压是最常见的符合条件的疾病 (78.7%)。有一种趋势是，干预患者更有可能补充至少一种缺口药物（30.6% 对比 18.0%； P = 0.12）和所有缺口药物（17.8% 对比 10.0%； P = 0.27）。结论：有可能在医疗保健提供系统内建立自动化流程，以识别药物依从性存在差距的患者，并发送推动以促进药物补充。 短信助推可能是一种可行且有效的促进药物补充的方法。目前正在进行一项大型多中心随机试验，以确定基于文本的助推对整体 CVD 发病率和死亡率的影响，以进一步探索这一点。唯一标识符：NCT03973931。