Personalized Patient Data and Behavioral Nudges to Improve Adherence to Chronic Cardiovascular Medications (The Nudge Study)
Overview
- Phase
- N/A
- Intervention
- Not specified
- Conditions
- Cardiovascular Diseases
- Sponsor
- University of Colorado, Denver
- Enrollment
- 9501
- Locations
- 4
- Primary Endpoint
- Medication Adherence
- Status
- Completed
- Last Updated
- last year
Overview
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.
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 include clinical events (e.g., event times for stroke, MI, mortality), utilization of care (e.g., hospitalizations or clinic visits for CV-related reasons), and costs of healthcare utilization. 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.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Patients with the following cardiovascular conditions and respective medication classes:
- •Hypertension (Beta-blockers \[B-blockers)\], Calcium Channel Blocker \[CCB\], Angiotensin converting enzyme inhibitors (ACEi), Angiotensin Receptor Blockers \[ARB\], or Thiazide diuretic)
- •Hyperlipidemia (HMG CoA reductase inhibitor \[Statins\])
- •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)
- •Atrial fibrillation (Direct oral anticoagulants, B-blockers, CCB)
Exclusion Criteria
- •Patients who do not have a mailing address listed in EHR;
- •Patients who do not have a landline or cellphone listed in EHR;
- •Currently pregnant if denoted in the EHR at the time of the data pull;
- •Patients with a mailing address outside of the state of Colorado;
- •Patients that do not speak either English or Spanish.
Outcomes
Primary Outcomes
Medication Adherence
Time Frame: 12 months after intervention
The primary outcome was medication adherence defined by the proportion of days covered (PDC) using pharmacy refill data adjusted difference from usual care.
Mean Proportion of Days Covered Relative to Usual Care
Time Frame: 12 months
We analyzed this longitudinal data (up to 12 observations per patient) and estimated absolute differences in PDC between treatment arms and usual care using a Generalized Estimating Equation (GEE) model with an identity link and independence with unequal variances for the covariance structure of the 12 observations .A multistage gatekeeper approach was used to account for multiple treatment comparisons by comparing each of the 3 treatment arms to the control in stage 1 using significance levels of 0.05/3, and if any test was significant, a significance level of (R/3)\*(0.05/3) using the Holm method was used for the 3 pairwise comparisons, where R is the number of significant stage 1 tests.
Secondary Outcomes
- Hospitalization(one year)
- Death(one year)
- Emergency Department Visit(one year)