Mobile phone‐based interventions for improving adherence to medication prescribed for the primary prevention of cardiovascular disease in adults

Melissa J Palmer; Sharmani Barnard; Pablo Perel; Caroline Free

doi:10.1002/14651858.CD012675.pub2

Scolaris Content Display Scolaris Content Display

Contenido relacionado

Ir a:

Revisiones y protocolos relacionados
Respuestas clínicas Cochrane
Guías
Temas

Revisiones y protocolos relacionados

Respuestas clínicas Cochrane

Topics

Temas

Figure 1

Study flow diagram.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.1

Comparison 1 Mobile phone intervention versus control, Outcome 1 Change in low‐density lipoprotein cholesterol (mg/dL).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.2

Comparison 1 Mobile phone intervention versus control, Outcome 2 Change in total cholesterol (mg/dL).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.3

Comparison 1 Mobile phone intervention versus control, Outcome 3 Change in high‐density lipoprotein cholesterol (mg/dL).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.4

Comparison 1 Mobile phone intervention versus control, Outcome 4 Change in systolic blood pressure (mmHg).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.5

Comparison 1 Mobile phone intervention versus control, Outcome 5 Change in diastolic blood pressure (mmHg).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Summary of findings for the main comparison. Mobile phone interventions compared to usual care for improving adherence to medication prescribed for primary prevention of cardiovascular disease

Mobile phone interventions compared to usual care for improving adherence to medication prescribed for primary prevention of cardiovascular disease
Patient or population: people prescribed medication for primary prevention of cardiovascular disease Setting: community‐based primary care or outpatient clinics in high‐income (Canada, Spain) and upper‐ to middle‐income countries (South Africa, China) Intervention: mobile phone‐based interventions Comparison: usual care
Outcomes	Impact	№ of participants (studies)	Quality of the evidence (GRADE)
Cholesterol (low‐density lipoprotein) follow‐up: range 1–2 years	1 study found evidence of a small beneficial intervention effect on reducing LDL‐C (–9.20 mg/dL), and 1 study found a very small increase in LDL‐C (0.77 mg/dL) with wide confidence intervals that included no effect.	893 (2 RCTs)	⊕⊕⊝⊝ Low^a,b
Systolic blood pressure follow‐up: range 1–2 years	3 of the 4 studies found lower systolic blood pressure with mobile phone interventions, but the size of effect varied. 2 studies showed moderate and large reductions in systolic blood pressure (–7.10 and –12.45 mmHg). 1 multi‐arm trial found small reductions with information‐only text messages (–2.1) and interactive text messaging (–1.6 mmHg) arms. 1 study found a slight increase in blood pressure (0.83 mmHg) but with wide confidence intervals that included no effect.	2194 (4 RCTs)	⊕⊕⊝⊝ Low^a,b
Diastolic blood pressure follow‐up: range 1–2 years	2 of 3 studies found lower diastolic blood pressure with mobile phone interventions, but the size of the effect varied. 2 studies showed large and small reductions in diastolic blood pressure (–12.23 and –3.90 mmHg), and 1 study found a slight increase in diastolic blood pressure (1.64 mmHg) but with wide confidence intervals that included no effect.	998 (3 RCTs)	⊕⊕⊝⊝ Low^a,b
Combined CVD events	Not reported	(0 studies)	—
Adverse events follow‐up: range 1–2 years	1 study reported that there were 0 adverse events attributable to the intervention. 1 study report that there was no difference between groups in experience adverse effects of statins, and that 0 participants reported intervention‐related adverse events.	1500 (2 RCTs)	⊕⊕⊝⊝ Low^b,c
Cognitive outcome: satisfaction with treatment follow‐up: mean 1 year	1 study measured satisfaction with treatment, and found no evidence of a difference between intervention and control arms.	1190 (1 RCT)	⊕⊕⊝⊝ Low^d,e
LDL‐C: low‐density lipoprotein cholesterol; RCT: randomised controlled trial.
GRADE Working Group grades of evidence High quality: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate quality: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low quality: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low quality: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.
^aDowngraded one level for inconsistency: trial results included large variations in the degree to which the outcome was affected. ^bDowngraded one level for risk of bias: all trials at unclear risk of bias on multiple domains. ^cDowngraded one level for imprecision: very low number of events. ^dDowngraded one level for indirectness: based on a single trial conducted in a single setting (public sector clinic in Cape Town, South Africa). ^eDowngraded one level for risk of bias: trial at unclear risk of bias on two domains.

Summary of findings for the main comparison. Mobile phone interventions compared to usual care for improving adherence to medication prescribed for primary prevention of cardiovascular disease

Ir a la tabla de la revisión

Table 1. Indirect measures of adherence

Trial	Outcome measure	Comparison	Intervention	Number (intervention)	Control	Number (Control)	Narrative results
Bobrow 2016 (1‐year follow‐up)	Proportion of days covered by dispensed medicine	Information‐only SMS vs control	83.3% (95% CI 69.3 to 91.7)	457	79.2% (95% CI 64.6 to 91.4)	458	Median difference 5.2, quartiles 1‐3: 1.5 to 8.9; P = 0.006
	Proportion of days covered by dispensed medicine	Interactive SMS vs control	83.3% (95% CI 66.7 to 91.7)	457	79.2% (95% CI 64.6 to 91.4)	458	Median difference 3.8; quartiles 1‐3: 0.03 to 7.6; P = 0.048
	Proportion of participants with proportion of days covered ≥ 80%	Information‐only SMS vs control	63%	457	49.4%	458	Adjusted odds ratio 1.86, 95% CI 1.39 to 2.49; P < 0.001
		Interactive SMS vs control	60%	457	49.4%	458	Adjusted odds ratio 1.60, 95% CI 1.20 to 2.16; P = 0.002
	Self‐reported medication adherence (score range 5–10)	Information‐only SMS vs control	10 (quartiles 1‐3: 9 to 10)	457	10 (quartiles 1‐3: 9 to 10)	458	Median difference 0.04, 95% CI –0.1 to 0.2; P = 0.70
	Self‐reported medication adherence (score range 5–10)	Interactive SMS vs control	10 (quartiles 1‐3: 9 to 10)	457	10 (quartiles 1‐3: 9 to 10)	458	Median difference 0.02, 95% CI –0.2 to 0.2; P = 0.80
Parraga‐Martinez 2017 (2‐year follow‐up)	Proportion adherent according to self‐reported medication adherence (measured using 'adapted Morisky‐Green test')	—	77.2%	Disaggregated not reported	64.1%	Disaggregated not reported	P = 0.029 220 in total, not reported by group
CI: confidence interval; SMS: short messaging service.

Table 1. Indirect measures of adherence

Ir a la tabla de la revisión

Comparison 1. Mobile phone intervention versus control

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Change in low‐density lipoprotein cholesterol (mg/dL) Show forest plot	2		Mean Difference (Fixed, 95% CI)	Totals not selected

2 Change in total cholesterol (mg/dL) Show forest plot	2		Mean Difference (Fixed, 95% CI)	Totals not selected

3 Change in high‐density lipoprotein cholesterol (mg/dL) Show forest plot	2		Mean Difference (Fixed, 95% CI)	Totals not selected

4 Change in systolic blood pressure (mmHg) Show forest plot	4		Mean Difference (Fixed, 95% CI)	Totals not selected

5 Change in diastolic blood pressure (mmHg) Show forest plot	3		Mean Difference (Fixed, 95% CI)	Totals not selected

Comparison 1. Mobile phone intervention versus control

Ir a la tabla de la revisión

The Cochrane Library

Scolaris Language Selector Scolaris Language Selector

Idioma de la Revisión Cochrane

Idioma de la web

Scolaris Content Language Banner Portlet Scolaris Content Language Banner Portlet