儿童哮喘药物的量身定制依从性激励

IF 24.7 1区医学 Q1 PEDIATRICS

JAMA Pediatrics Pub Date : 2025-03-17 DOI:10.1001/jamapediatrics.2025.0010

Chén C. Kenyon, William O. Quarshie, Rui Xiao, Mishaal Yazdani, Carina M. Flaherty, G. Chandler Floyd, Victoria A. Miller, Tyra C. Bryant-Stephens, Joseph J. Zorc, Chris Feudtner

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引用次数: 0

摘要

对有效预防药物的不同依从性是儿童哮喘结局种族差异的一个潜在可改变的驱动因素。目的：确定经济激励增强干预对高危、少数族裔哮喘患儿吸入性哮喘预防药物依从性的影响。设计、环境和参与者这是一项随机临床试验，于2019年9月至2022年6月在美国大西洋中部的一个大型儿科卫生系统进行。如果儿童年龄在5到12岁之间，每天使用预防性吸入器，并且在前一年至少有2次哮喘发作需要全身性类固醇，则符合条件。数据分析时间为2022年12月至2024年12月。干预措施使用电子吸入器传感器监测吸入药物使用7个月。在为期3个月的实验间隔中，完成1个月跑步间隔的家庭被随机分为3组中的1组：(1)每日短信药物提醒，每周依从性反馈，以及每天高达1美元的收益框架经济激励（完全干预）；(2)每日短信用药提醒和每周依从性反馈（混合干预）；或者(3)没有提醒、反馈或激励（主动控制）。药物依从性监测继续进行3个月的观察间隔，所有组恢复到积极的对照状态。主要观察指标：实验期间吸入维持药物的依从性；次要结局包括观察期的依从性。该研究旨在检测完全干预和主动控制条件下平均每月依从性的差异。结果106例患儿中，有至少1个月监测数据的99例，其中男56例（57%），女43例（43%）；平均[SD]年龄，8.0[2.3]岁)。大多数参与者（81人[82%]）被确定为非西班牙裔黑人，各研究组的人口统计学和临床特征相似。在实验期间，与主动对照组相比，接受全面干预的参与者吸入维持药物依从性高出15个百分点（95% CI， 2-29个百分点）。在观察期间，没有证据表明依从性有差异。结论和相关性虽然与积极对照组相比，财政激励增强的移动健康干预导致更高的吸入预防性药物依从性，但没有证据表明干预成分停止后效果持久，这与其他包括财政激励鼓励行为改变的研究一致。临床试验注册号：NCT03907410

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Tailored Adherence Incentives for Childhood Asthma Medications

ImportanceDifferential adherence to efficacious preventive medications is one potentially modifiable driver of racial disparities in childhood asthma outcomes.ObjectiveTo determine the effect of a financial incentive-enhanced intervention on adherence to inhaled asthma preventive medication in a high-risk, predominantly racially minoritized cohort of children with asthma.Design, Setting, and ParticipantsThis was a randomized clinical trial conducted from September 2019 through June 2022 at a large mid–Atlantic pediatric health system in the US. Children were eligible if they were between 5 and 12 years old, prescribed a preventive inhaler for daily use, and had at least 2 asthma exacerbations requiring systemic steroids in the preceding year. Data were analyzed from December 2022 to December 2024.InterventionInhaled medication use was monitored using electronic inhaler sensors over a 7-month period. Families who completed a 1-month run-in interval were randomized to 1 of 3 arms for a 3-month experiment interval: (1) daily text message medication reminders, weekly adherence feedback, and gain-framed, financial incentives of up to $1 per day (full intervention); (2) daily text message medication reminders and weekly adherence feedback (hybrid intervention); or (3) no reminders, feedback, or incentives (active control). Medication adherence monitoring then continued for a 3-month observation interval, where all arms reverted to active control conditions.Main Outcomes and MeasuresThe primary outcome was adherence to inhaled maintenance medication during the experiment; secondary outcomes included adherence during the observation phase. The study was powered to detect a difference in average monthly adherence between the full intervention and active control condition.ResultsOf the 106 children randomized, 99 had at least 1 month of monitoring data (56 male [57%] and 43 female [43%]; mean [SD] age, 8.0 [2.3] years). Most participants (81 [82%]) identified as non-Hispanic Black and demographic and clinical characteristics were similar across study arms. During the experiment interval, participants receiving the full intervention had a 15–percentage point (95% CI, 2-29 percentage points) higher inhaled maintenance medication adherence compared with participants in the active control. There was no evidence of adherence differences in the observation interval.Conclusion and RelevanceWhile a financial incentive-enhanced mobile health intervention led to higher inhaled preventive medication adherence as compared with the active control group, there was no evidence for enduring effect after the intervention components ceased, consistent with other studies that include financial incentives to encourage behavior change.Trial RegistrationClinicalTrials.gov Identifier: NCT03907410

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来源期刊

JAMA Pediatrics PEDIATRICS-

CiteScore

31.60

自引率

1.90%

发文量

357

期刊介绍： JAMA Pediatrics, the oldest continuously published pediatric journal in the US since 1911, is an international peer-reviewed publication and a part of the JAMA Network. Published weekly online and in 12 issues annually, it garners over 8.4 million article views and downloads yearly. All research articles become freely accessible online after 12 months without any author fees, and through the WHO's HINARI program, the online version is accessible to institutions in developing countries. With a focus on advancing the health of infants, children, and adolescents, JAMA Pediatrics serves as a platform for discussing crucial issues and policies in child and adolescent health care. Leveraging the latest technology, it ensures timely access to information for its readers worldwide.