What is the clinical evidence from this study?

Study design: RCT. Population: Uncontrolled hypertension (n=123). Intervention: BPMED (automated text messaging system) vs. Usual care. Primary outcome: Change in medication adherence (Morisky Medication Adherence Scale) (p=0.26).

February 1, 2017JMIR mhealth and uhealthOpen Access

Text Messaging to Improve Hypertension Medication Adherence in African Americans From Primary Care and Emergency Department Settings: Results From Two Randomized Feasibility Studies

Q: What does this research mean for the field?

An automated text messaging intervention (BPMED) is feasible and highly acceptable for African Americans with uncontrolled hypertension, resulting in numerically greater but nonsignificant improvements in medication adherence and blood pressure compared to usual care. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

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Key result

BPMED text message reminders resulted in numerically greater but nonsignificant improvements in medication adherence compared to usual care among African Americans with uncontrolled hypertension.

Why the study?

Does an automated text messaging system (BPMED) improve medication adherence in African Americans with uncontrolled hypertension?

Population

123 African-American adults with uncontrolled hypertension, recruited from primary care and emergency…

Comparison

BPMED: an automated text messaging system… vs Usual care for one month.

Design

RCT, Block randomization, with blocks of 10 generated by the study…

Follow-up

one month

Authors

LBLorraine R BuisPreventive Cardiology LHLindsey HirzelWayne State University RDRachelle DawoodWayne State University

Discussion

Member takes

Implication

No significant adherence benefit from text reminders in this pilot RCT; leaves open efficacy in larger trials.

Study Design

Type

RCT (n=123)

Blinding

Open-label

Randomization

Block randomization

Multicenter

Yes

Structured PICO

Does an automated text messaging system (BPMED) improve medication adherence in African Americans with uncontrolled hypertension?

Population

123 African-American adults with uncontrolled hypertension, recruited from primary care (n=58) and emergency department (n=65) settings. Mean age 49.0, 55.4% female. US-based (Detroit and Southfield, MI).

Intervention

BPMED: an automated text messaging system sending daily medication reminders at individually customized times and two educational messages per week for one month.

Comparator

Usual care for one month.

Outcome

Medication adherence as quantified by the self-reported 8-item Morisky Medication Adherence Scale (MMAS) at one-month follow-up.patient reported

Main Result

Absolute Event Rate: 0.9% vs 0.5%

p-value: p=0.26

Automated text message reminders for medication adherence are highly acceptable and feasible among African Americans with uncontrolled hypertension, though a one-month pilot study did not show statistically significant improvements in adherence or blood pressure.

Limitations

Small sample size (underpowered to detect modest differences)
Short-term follow-up period of only one month
Use of a self-reported measure for medication adherence (MMAS) which can suffer from overestimation
Potential Hawthorne effect due to the unblinded study design
Single component intervention (unidirectional text messaging) which may be less effective than multicomponent approaches
Small sample size (underpowered)
Short-term follow-up period
Self-reported measure of medication adherence (MMAS) which can suffer from overestimation
Hawthorne effect among control participants
Single component approach (unidirectional text messaging)

Cite This Study

Buis et al. (2017) conducted an RCT in Uncontrolled hypertension (n=123). BPMED (automated text messaging system) vs. Usual care was evaluated on Change in medication adherence (Morisky Medication Adherence Scale) (p=0.26). BPMED text message reminders resulted in numerically greater but nonsignificant improvements in medication adherence compared to usual care among African Americans with uncontrolled hypertension.

synapsesocial.com/papers/6a1882ce3ad5dee7381ee4cc https://doi.org/10.2196/mhealth.6630

Topics

Hypertension management

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Text Messaging to Improve Hypertension Medication Adherence in African Americans From Primary Care and Emergency Department Settings: Results From Two Randomized Feasibility Studies

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Topics

Text Messaging to Improve Hypertension Medication Adherence in African Americans From Primary Care and Emergency Department Settings: Results From Two Randomized Feasibility Studies

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Topics

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