A randomized controlled behavioral intervention trial to improve medication adherence in adult stroke patients with prescription tailored Short Messaging Service (SMS)-SMS4Stroke study

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Abstract

Background

The effectiveness of mobile technology to improve medication adherence via customized Short Messaging Service (SMS) reminders for stroke has not been tested in resource poor areas. We designed a randomized controlled trial to test the effectiveness of SMS on improving medication adherence in stroke survivors in Pakistan.

Methods

This was a parallel group, assessor-blinded, randomized, controlled, superiority trial. Participants were centrally randomized in fixed block sizes. Adult participants on multiple medications with access to a cell phone and stroke at least 4 weeks from onset (Onset as defined by last seen normal) were eligible. The intervention group, in addition to usual care, received reminder SMS for 2 months that contained a) Personalized, prescription tailored daily medication reminder(s) b) Twice weekly health information SMS. The Health Belief Model and Social Cognitive theory were used to design the language and content of messages. Frontline SMS software was used for SMS delivery. Medication adherence was self-reported and measured on the validated Urdu version of Morisky Medication Adherence Questionnaire. Multiple linear regression was used to model the outcome against intervention and other covariates. Analysis was conducted by intention-to-treat principle.

Results

Two hundred participants were enrolled. 38 participants were lost to follow-up. After 2 months, the mean medication score was 7.4 (95 % CI: 7.2–7.6) in the intervention group while 6.7 (95 % CI: 6.4–7.02) in the control group. The adjusted mean difference (Δ) was 0.54 (95 % CI: 0.22–0.85). The mean diastolic blood pressure in the intervention group was 2.6 mmHg (95 % CI; −5.5 to 0.15) lower compared to the usual care group.

Conclusion

A short intervention of customized SMS can improve medication adherence and effect stroke risk factors like diastolic blood pressure in stroke survivors with complex medication regimens living in resource poor areas.

Trial registration

Clinicaltrials.gov NCT01986023 last accessed at https://clinicaltrials.gov/ct2/show/NCT01986023

Electronic supplementary material

The online version of this article (doi:10.1186/s12883-015-0471-5) contains supplementary material, which is available to authorized users.

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Most cited references 34

Record: found
Abstract: found
Article: not found

Patient medication adherence: measures in daily practice.

Beena Jimmy, Jimmy Jose (2011)

Adherence to therapies is a primary determinant of treatment success. Failure to adherence is a serious problem which not only affects the patient but also the health care system. Medication non adherence in patients leads to substantial worsening of disease, death and increased health care costs. A variety of factors are likely to affect adherence. Barriers to adherence could be addressed as patient, provider and health system factors, with interactions among them. Identifying specific barriers for each patient and adopting suitable techniques to overcome them will be necessary to improve medication adherence. Health care professionals such as physicians, pharmacists and nurses have significant role in their daily practice to improve patient medication adherence.

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Record: found
Abstract: found
Article: not found

New medication adherence scale versus pharmacy fill rates in seniors with hypertension.

Donald E. Morisky, R Dal-Ré, Marie Wood … (2008)

To evaluate the association and concordance of the new 8-item self-report Morisky Medication Adherence Scale (MMAS) with pharmacy fill data in a sample of community-dwelling seniors with hypertension. Cross-sectional study. Pharmacy records for antihypertensive medications were abstracted for 87 managed care adult patients with hypertension 65 years and older who completed a survey that included the MMAS. Continuous single-interval medication availability (CSA), medication possession ratio (MPR), and continuous multiple-interval medication gaps (CMG) were calculated using pharmacy data. The MMAS adherence was categorized as high, medium, and low (MMAS scores of 8, 6 to <8, and <6, respectively); pharmacy fill nonpersistence was defined as less than 0.8 for CSA and MPR and as greater than 0.2 for CMG. Overall, 58%, 33%, and 9% of participants had high, medium, and low medication adherence, respectively, by the MMAS. After adjustment for demographics and in comparison to high adherers on the MMAS, patients with low MMAS adherence were 6.89 (95% confidence interval [CI], 2.48-19.10) times more likely to have nonpersistent pharmacy fill adherence by CSA and were 5.22 (95% CI, 1.88-14.50) times more likely to have nonpersistent pharmacy fill adherence by MPR. Concordance between the MMAS and CSA, MPR, and CMG was 75% or higher. The MMAS is significantly associated with antihypertensive drug pharmacy refill adherence. Although further validation of the MMAS is needed, it may be useful in identifying low medication adherers in clinical settings.

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Differences in risk factors, atherosclerosis, and cardiovascular disease between ethnic groups in Canada: the Study of Health Assessment and Risk in Ethnic groups (SHARE)

S Anand, S Yusuf, V. Vuksan … (2000)

Cardiovascular disease rates vary greatly between ethnic groups in Canada. To establish whether this variation can be explained by differences in disease risk factors and subclinical atherosclerosis, we undertook a population-based study of three ethnic groups in Canada: South Asians, Chinese, and Europeans. 985 participants were recruited from three cities (Hamilton, Toronto, and Edmonton) by stratified random sampling. Clinical cardiovascular disease was defined by history or electrocardiographic findings. Carotid atherosclerosis was measured with B-mode ultrasonography. Conventional (smoking, hypertension, diabetes, raised cholesterol) and novel risk factors (markers of a prothrombotic state) were measured. Within each ethnic group and overall, the degree of carotid atherosclerosis was associated with a higher prevalence of cardiovascular disease. South Asians had the highest prevalence of this condition compared with Europeans and Chinese (11%, 5%, and 2%, respectively, p=0.0004). Despite this finding, Europeans had more atherosclerosis (mean of the maximum intimal medial thickness 0.75 [0.16] mm) than South Asians (0.72 [0.15] mm), and Chinese (0.69 [0.16] mm). South Asians had an increased prevalence of glucose intolerance, higher total and LDL cholesterol, higher triglycerides, and lower HDL cholesterol, and much greater abnormalities in novel risk factors including higher concentrations of fibrinogen, homocysteine, lipoprotein (a), and plasminogen activator inhibitor-1. Although there are differences in conventional and novel risk factors between ethnic groups, this variation and the degree of atherosclerosis only partly explains the higher rates of cardiovascular disease among South Asians compared with Europeans and Chinese. The increased risk of cardiovascular events could be due to factors affecting plaque rupture, the interaction between prothrombotic factors and atherosclerosis, or as yet undiscovered risk factors.

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Author and article information

Contributors

Ayeesha Kamran Kamal: 9221-34930051-4669 , ayeesha.kamal@aku.edu

Quratulain Shaikh: quratulain.shaikh@aku.edu

Omrana Pasha: omrana.pasha@aku.edu

Iqbal Azam: iqbal.azam@aku.edu

Muhammad Islam: muhammad.islam@aku.edu

Adeel Ali Memon: adeel.ali.memon@gmail.com

Hasan Rehman: hasanrehman89@gmail.com

Masood Ahmed Akram: masood.ahmed.akram@gmail.com

Muhammad Affan: muhammad.affan87@gmail.com

Sumaira Nazir: drsumairapk@yahoo.com

Salman Aziz: memon.salman@gmail.com

Muhammad Jan: muhammad.jan@aku.edu

Anita Andani: anita.andani@aku.edu

Abdul Muqeet: abdul.muqeet@akdn.org

Bilal Ahmed: bilal.ahmed@aku.edu

Shariq Khoja: khojashariq@gmail.com

Journal

Journal ID (nlm-ta): BMC Neurol

Journal ID (iso-abbrev): BMC Neurol

Title: BMC Neurology

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2377

Publication date (Electronic): 21 October 2015

Publication date PMC-release: 21 October 2015

Publication date Collection: 2015

Volume: 15

Electronic Location Identifier: 212

Affiliations

[ ]Stroke Services, Section of Neurology, Department of Medicine, The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Aga Khan University, Stadium Road, 74800 Karachi, Pakistan

[ ]Fogarty Cerebrovascular Research Fellow, The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Aga Khan University, Karachi, Pakistan

[ ]Epidemiology and Biostatistics Program, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan

[ ]Department of Community Health Sciences, Biostatistics, Aga Khan University, Karachi, Pakistan

[ ]SMS4Stroke Study, The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Aga Khan University, Karachi, Pakistan

[ ]Stroke Service, Aga Khan University, Karachi, Pakistan

[ ]eHealth Innovation, Global, eHealth Resource Center, Aga Khan Development Network, Karachi, Pakistan

[ ]Epidemiology and Biostatistics, Department of Medicine, Aga Khan University, Karachi, Pakistan

[ ]Tech4Life Enterprises, and Technical Advisor-Evidence, Capacity & Policy mHealth Alliance, United Nations Foundation, Washington, USA

Article

Publisher ID: 471

DOI: 10.1186/s12883-015-0471-5

PMC ID: 4618367

PubMed ID: 26486857

SO-VID: 1c343dd7-de27-479e-9100-5b87091a5371

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 29 July 2015

Date accepted : 8 October 2015

Custom metadata

ScienceOpen disciplines: Neurology

Keywords: stroke,medication adherence,sms,prevention,non communicable disease,mhealth,it technology,lower and middle income countries,cost effectiveness

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ScienceOpen disciplines: Neurology

Keywords: stroke, medication adherence, sms, prevention, non communicable disease, mhealth, it technology, lower and middle income countries, cost effectiveness

A randomized controlled behavioral intervention trial to improve medication adherence in adult stroke patients with prescription tailored Short Messaging Service (SMS)-SMS4Stroke study

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Abstract

Background

Methods

Results

Conclusion

Trial registration

Electronic supplementary material

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Stroke MRI

Most cited references 34

Patient medication adherence: measures in daily practice.

New medication adherence scale versus pharmacy fill rates in seniors with hypertension.

Differences in risk factors, atherosclerosis, and cardiovascular disease between ethnic groups in Canada: the Study of Health Assessment and Risk in Ethnic groups (SHARE)

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