Günlük İlaç Hatırlatıcı Kısa Mesaj (SMS) Göndermenin Hipertansif Hastalarda Kan Basıncı Kontrolü ve İlaç Uyumu Üzerine Etkisi

Abstract

GİRİŞ:  Dünya Sağlık Örgütü(DSÖ) verilerine göre hipertansiyon, diyabet ve dislipidemi gibi kronik hastalıklarda uzun süreli medikal tedaviye uyumsuzluk bireylerin sağlığını ve ekonomik koşullarını ciddi dereced etkilemektedir. Antihipertansif ilaçların ortalama kullanım oranı %64’tür. Bu çalışmanın amacı günlük kısa mesaj(sms) göndermenin hipertansif hastalarda kan basıncı kontrolü ve ilaç uyumu üzerine etkisini değerlendirmektir.

YÖNTEM: Bu araştırma randomize kontrollü bir araştırmadır. Çalışmaya Marmara Üniversitesi Aile Hekimliği Polikliniğine başvuran ve hipertansif olduğu bilinen hastalar dahil edilmiştir. Katılımcılar randomizasyonla kontrol ve müdahale (sms) grubu olmak üzere iki gruba ayrılmıştır. Kontrol grubuna sadec rutin sağlık hizmeti verilmiş, müdahale grubuna buna ek olarak iki ay boyunca günlük hatırlatma mesajı yollanmıştır. Katılımcılardan ilk vizit ve son vizit öncesi bir haftalık kan basıncı(KB) takibi yapmaları istenmiştir ve her görüşmede KB ölçümleri yapılmıştır. İlaç uyumu Modifiye Morisky Ölçeği ile değerlendirilmiştir. Grupların KB ölçümleri ve ilaç uyumları karşılaştırılmıştır.

BULGULAR: İçerleme kriterlerini karşılayan 60 katılımcı çalışmaya dahil edildi. Katılımcıların 45’i kadın, 15’i erkekti. Katılımcıların yaş ortalaması 55±11; ortalama Beden kitle İndeksi (BMI)  30±5; günlük kullandıkları tablet sayısı ortalaması 4±2 idi. Her iki grubun ilk vizitteki KB ölçüm ortalamları ile ilk görüşme bir haftalık evde KB ölçüm ortalamaları birbirine benzer olarak bulundu.(p>0,05) Buna karşılık müdahale grubunun hem son vizitteki KB ölçüm ortalaması, hem de ikinci görüşme evde bir haftalık KB takip ölçüm ortalaması kontrol grubuna göre istatistiksel olarak anlamlı derecede düşük bulundu.(p<0,05) Ayrıca müdahale grubunun ilk-son visit KB ölçüm değişim ortalaması ile ilk-son görüşme bir haftalık KB ölçüm takibi değişimi ortalaması kontrol grubuna göre istatistiksel olarak anlamlı derecede yüksek bulundu.(p<0,05) Kontrol grubunun ilaç uyumu %36,7 iken, müdahale grubunun ilaç uyumu %96,7 olarak bulundu.

SONUÇ: Günlük ilaç hatırlatıcı kısa mesaj göndermek, hipertansiyon hastalarında kan basıncı kontrolünü sağlama ve ilaç uyumunu arttırmada etkilidir.

Keywords

• Uyum,antihipertansif,kısa mesaj,kan basıncı,hipertansiyon

Effects on Blood Pressure Control and Compliance For Medical Treatment in Hypertensive Patients By Sending Daily SMS as a Reminder

Abstract

BACKGROUND: According to the World Health Organization non-compliance in long term medical treatments such as hypertension, diabetes and dyslipidemia causes serious problems on patients health and general economic benefits. The average compliance ratio for using antihypertensive medications is 64%. The aim of this study is determine the effects on blood pressure control and compliance for medical treatment in hypertensive patients by sending daily `sms`.

METHOD: This is a randomized controlled study. Participants were selected among hypertensive patients of Marmara University department of family medicine outpatient clinics and randomized into sms and non-sms groups. While everyday an sms has been send to the patients in the sms group for two months, there was no intervention for the control group except routine care. One week ambulatory blood pressure measurements have been requested twice of all the patients. Blood pressure measurements were done at the first and the last visit. Medicine compliance was scaled by using Modified Morrisky Questionnaire. Blood pressure measurements and compliance for medical treatment of each group was compared.

RESULTS: A total of sixty patients who fulfilled the inclusion criteria were enrolled in the study:45 were female,15 male; mean age was 55±11; mean BMI was 30±5; mean number of tablets per day was 4±2. There was statistically significant difference between the first and the last visit measurements for SBP and DBP for the intervention group (p=0.051 for SBP, p=0.057 for DBP). No statistically significant difference has been determined in the control group. In intervention group one week ambulatory BP measurements averages differed between the first visit and the last visit (SBP 145±8mmHg/DBP 82±6mmHg; SBP 131±7mmHg/DBP 73±7mmHg; p < 0.001). Medicine compliance ratio was 36,7% for the control group, 96,7% for the intervention group.

CONCLUSION: Reminding taking antihypertensive treatment with daily sms is an effective method to control blood pressure and and to raise compliance in hypertensive patients. 

Keywords

• Compliance,antihypertensive,sms,blood pressure,hypertension

References

1. Hipertansiyon, Türk. "Böbrek Hastalıkları Derneği, 2012. Türk Hipertansiyon Prevalans Çalışması PatenT2." (2015).
2. Arıcı, M., et al. "[Turkish Hypertension Consensus Report]." Turk Kardiyoloji Dernegi arsivi: Turk Kardiyoloji Derneginin yayin organidir 43.4 (2015): 402-409.
3. Bartels, David. "Adherence to oral therapy for type 2 diabetes: opportunities for enhancing glycemic control." Journal of the American Academy of Nurse Practitioners 16.1 (2004): 9-17.
4. Baune, Bernhard T., Yousef I. Aljeesh, and Ralf Bender. "The impact of non-compliance with the therapeutic regimen on the development of stroke among hypertensive men and women in Gaza, Palestine." Saudi medical journal 25.11 (2004): 1683-1688.
5. Cramer, J. A., et al. "The significance of compliance and persistence in the treatment of diabetes, hypertension and dyslipidaemia: a review." International journal of clinical practice 62.1 (2008): 76-87.
6. Hacıhasanoğlu, R. "Treatment compliance affecting factors in hypertension." Türk Si̇lahlı Kuvvetleri̇, Koruyucu Heki̇mli̇k Bülteni̇ 8.2 (2009): 167-172.
7. Widmer, R. Jay, et al. "Digital health interventions for the prevention of cardiovascular disease: a systematic review and meta-analysis." Mayo Clinic Proceedings. Vol. 90. No. 4. Elsevier, 2015.
8. García-Lizana, Francisca, and Antonio Sarría-Santamera. "New technologies for chronic disease management and control: a systematic review." Journal of telemedicine and telecare 13.2 (2007): 62-68.

9. Krishna, Santosh, Suzanne Austin Boren, and E. Andrew Balas. "Healthcare via cell phones: a systematic review." Telemedicine and e-Health 15.3 (2009): 231-240.
10. Saeedi, Osamah J., et al. "Potential limitations of e-mail and text messaging in improving adherence in glaucoma and ocular hypertension." Journal of glaucoma 24.5 (2015): e95-e102.
11. Vervloet, Marcia, et al. "The effectiveness of interventions using electronic reminders to improve adherence to chronic medication: a systematic review of the literature." Journal of the American Medical Informatics Association 19.5 (2012): 696-704.
12. Park, Linda G., Jill Howie Esquivel, and Kathleen Dracup. "A quantitative systematic review of the efficacy of mobile phone interventions to improve medication adherence." Journal of advanced nursing 70.9 (2014): 1932-1953.
13. Thakkar, Jay, et al. "Mobile telephone text messaging for medication adherence in chronic disease: a meta-analysis." JAMA internal medicine 176.3 (2016): 340-349.
14. Gatwood, Justin, et al. "The impact of tailored text messages on health beliefs and medication adherence in adults with diabetes: A randomized pilot study." Research in Social and Administrative Pharmacy 12.1 (2016): 130-140.
15. Strandbygaard, Ulla, Simon Francis Thomsen, and Vibeke Backer. "A daily SMS reminder increases adherence to asthma treatment: a three-month follow-up study." Respiratory medicine 104.2 (2010): 166-171.
16. Lester, Richard T., et al. "Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): a randomised trial." The Lancet 376.9755 (2010): 1838-1845.
17. Hou, Melody Y., et al. "Using daily text-message reminders to improve adherence with oral contraceptives: a randomized controlled trial." Obstetrics & Gynecology 116.3 (2010): 633-640.
18. Fjeldsoe, Brianna S., Alison L. Marshall, and Yvette D. Miller. "Behavior change interventions delivered by mobile telephone short-message service." American journal of preventive medicine 36.2 (2009): 165-173.
19. Bobrow, Kirsty, et al. "Efficacy of a text messaging (SMS) based intervention for adults with hypertension: protocol for the StAR (SMS Text-message Adherence suppoRt trial) randomised controlled trial." BMC public health 14.1 (2014): 1.
20. Margolis, Karen L., et al. "A Successful Multifaceted Trial to Improve Hypertension Control in Primary Care: Why Did it Work?." Journal of general internal medicine 30.11 (2015): 1665-1672.
21. Farris, Karen B., et al. "Confirming the theoretical structure of expert-developed text messages to improve adherence to anti-hypertensive medications." Research in Social and Administrative Pharmacy 12.4 (2016): 578-591.