A mobile application with financial incentives did not improve median medication adherence at 90 days compared to standard care (95.6% vs 95.6%, p=0.47) in hypertensive outpatients.
RCT (n=219)
open-label
randomized
Yes
Does a medication adherence mobile application with or without financial incentives improve medication adherence and blood pressure in hypertensive outpatients?
A mobile health application with or without financial incentives did not improve medication adherence or blood pressure in hypertensive outpatients who already had very high baseline adherence.
Absolute Event Rate: 95.6% vs 95.6%
p-value: p=0.47
Objective: Non-adherence to antihypertensive therapy remains a major barrier to optimal blood pressure (BP) control. This study evaluated whether a multi-faceted medication adherence mobile application (mApp), with or without financial incentives (FI), improves adherence and BP compared with standard care. Design and method: In this multicenter, randomized, open-label trial, 219 hypertensive outpatients taking at least 4 pills/day were randomized to (A) mApp with FI, (B) mApp without FI, or (C) standard-of-care. Adherence was measured by Medication Event Monitoring System (MEMS) dispensers. Self-reported adherence was measured with a Hill Bone Scale. 24h BP measurements were taken at baseline (BL), 90 days (EP) and 180 days (eFU). Primary endpoint was median adherence at 90 days comparing A with C; the co-primary endpoint compared adherence during month 3 versus month 1. Secondary outcomes included the named comparisons between A and B, as well as changes in ambulatory BP, and self-reported adherence over 90 and 180 days. Results: Of 219 randomized participants, 176 (80.4%) completed the 90-day visit (median age 63 years; 23% women). Median adherence at EP was 95.6% in A and C (p=0.47, Figure A). Median change in adherence from month 3 to month 1 was 0% in A and 1.6% in C (p=0.70, Figure B). Self-reported adherence did not differ between groups, although within-group analyses showed improvement over time in A (p=0.002, Figure C). Systolic ambulatory BP did not differ between groups at BL, EP and eFU, and there was no significant improvement over time (Figure D).Conclusions: In hypertensive outpatients with a very high baseline adherence, neither the mApp nor FI improved MEMS-measured adherence or BP, indicating that the intervention primarily reached highly motivated participants. Future interventions should therefore focus on engaging patients with low baseline adherence and uncontrolled hypertension, for whom digital strategies may have greater impact.
Vischer et al. (Fri,) conducted a rct in hypertension (n=219). Mobile application (mApp) with financial incentives (FI) vs. Standard-of-care was evaluated on Median adherence at 90 days (p=0.47). A mobile application with financial incentives did not improve median medication adherence at 90 days compared to standard care (95.6% vs 95.6%, p=0.47) in hypertensive outpatients.