Behavioral Economics and Medication Adherence for Hypertension: A Randomized Clinical Trial.

Mobile health (mHealth)-based behavioral economic interventions may improve adherence, but remain largely untested, especially in vulnerable populations.

基于移动健康（mHealth）的行为经济学干预措施可能改善依从性，但这些措施在很大程度上尚未经过测试，特别是在脆弱人群中。

The study sought to test whether an mHealth incentive lottery would lower systolic blood pressure (SBP) and improve adherence.

该研究旨在测试移动健康激励抽奖是否能降低收缩压（SBP）并提高依从性。

Methods

BETTER-BP (Behavioral Economics Trial To Enhance Regulation of Blood Pressure) was a randomized trial conducted in 3 safety-net clinics in New York City.

BETTER-BP（行为经济学试验以增强血压调节）是在纽约市的三家安全网诊所进行的随机试验。

Eligible participants were adults with hypertension prescribed at least 1 antihypertensive medication, with SBP >140 mm Hg, and poor self-reported adherence.

符合条件的参与者是被开具至少一种降压药物的成年高血压患者，收缩压(SBP) >140毫米汞柱，并且自我报告依从性差。

In the intervention arm, an incentive lottery was administered via SMS messaging.

在干预组中，通过短信消息管理实施了激励性彩票。

All participants received passive adherence monitoring.

所有参与者均接受了被动依从性监测。

The intervention lasted 6 months, with continued monitoring until 12 months.

干预措施持续了6个月，并继续监测至12个月。

The primary clinical endpoint was change in SBP at 6 months.

主要临床终点是6个月时收缩压（SBP）的变化。

The primary process endpoint was adequate antihypertensive medication adherence (≥80% days adherent) from baseline to 6 months.

主要过程终点是从基线到6个月期间，患者对降压药物的依从性达到足够的水平（≥80%的依从天数）。

Results

Four-hundred participants (265 intervention:135 control) were enrolled with median age 57 years, 60.5% women, 61.5% Hispanic, and 20.3% non-Hispanic Black.

共有400名参与者（265名干预组：135名对照组）被纳入研究，中位年龄为57岁，女性占60.5%，西班牙裔占61.5%，非西班牙裔黑人占20.3%。

Over 70% had Medicaid or no insurance.

超过70%的参与者拥有医疗补助或无保险。

At 6 months, intervention arm participants were twice as likely to achieve adequate adherence (71% vs 34%; adjusted risk ratio: 2.04; 95% CI: 1.58-2.63), but there was no significant change in mean SBP (-6.7 mm Hg intervention vs -5.8 mm Hg control; P = 0.62).

在6个月时，干预组参与者达到足够依从性的可能性是对照组的两倍（71%对比34%；调整后的风险比：2.04；95%置信区间：1.58-2.63），但平均收缩压（SBP）没有显著变化（干预组-6.7 mm Hg对比对照组-5.8 mm Hg；P = 0.62）。

From 6 to 12 months, adherence was similar (31% intervention vs 26% control; adjusted risk ratio: 1.17; 95% CI: 0.83-1.65).

从6个月到12个月，依从性相似（干预组31%对比对照组26%；调整后的风险比：1.17；95%置信区间：0.83-1.65）。

Conclusions

In a diverse safety-net population, the BETTER-BP intervention doubled the rate of adequate antihypertensive medication adherence but did not reduce SBP at 6 months.

在一个多元化的安全网人群中，BETTER-BP干预措施使足够的抗高血压药物依从性率翻了一番，但在6个月时并未降低收缩压。