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NRI 15-455 – HSR&D Study

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NRI 15-455
Mobile Health Strategies for Veterans with Coronary Heart Disease
Linda Grace Park PhD MS NP
San Francisco VA Medical Center, San Francisco, CA
San Francisco, CA
Funding Period: December 2017 - November 2020

BACKGROUND/RATIONALE:
Coronary heart disease is the leading cause of death in Veterans and affects 15.5 million people in the United States. Antiplatelet medications have contributed to the decline of coronary heart disease related deaths. Despite this, medication nonadherence in patients with coronary heart disease is closely linked to adverse clinical outcomes such as rehospitalization and mortality. To promote medication adherence, effective and novel strategies are urgently needed to prevent adverse clinical outcomes. This seeks to determine whether mobile health technology in the form of text messaging or a mobile application (app) will improve medication adherence among Veterans with coronary heart disease.

OBJECTIVE(S):
The objective of this study is to determine whether text messaging or a mobile app, compared with a general educational website-control, can improve adherence to antiplatelet medications among Veterans with coronary heart disease. The specific aims of this study are to: (1) determine preferences for content and frequency of text messaging to promote medication adherence; (2) determine the most patient-centered mobile app to promote medication adherence; and (3) compare adherence to antiplatelet medications via text messaging, mobile app, or website-control upon hospital discharge.

METHODS:
This is a mixed methods study using both qualitative and quantitative methods. Focus groups will be used to fulfill the objectives of aims 1 and 2. Up to 32 participants at least 21 years of age, with a history of coronary heart disease within one year, and a current or former antiplatelet prescription will be recruited to attend three focus group sessions. Session one will explore different content for text messaging to determine the ideal, tailored text message. In session two, participants will explore different apps related to medication adherence and discuss facilitators and barriers to using mobile apps. In between sessions two and three, participants will test two of the mobile apps for one week each, and will report feedback about the apps in session three. The information gathered from the focus groups will be analyzed and used to inform aim 3, which is a randomized controlled trial. Up to 225 participants at least 21 years old, with a history of coronary heart disease within one week, and a new antiplatelet prescription will be recruited. Participants will be randomly assigned to one of three groups: (1) text messaging, (2) mobile app, or (3) website-control for 12 months. Medication adherence will be assessed using the Medication Event Monitoring System, which used integrated microcircuits with bottle caps to record the date and time a participant opens their pill bottle. A sample of non-Veteran, female participants meeting the same eligibility criteria for all aims will be enrolled from John Muir Medical Center to get a representative sample of both sexes.

FINDINGS/RESULTS:
There have been no new findings since the last update. The project has just started recruitment for Aim 3 at John Muir Medical Center. Recruitment at the VA sites has not occurred yet.

IMPACT:
Improving medication adherence through an innovative solution, such as mobile health technology, may have significant effects on lowering adverse outcomes among Veterans with coronary heart disease. Findings from this study may also be applicable to non-Veterans with coronary heart disease and other patients with chronic diseases who require long-term medication use.

PUBLICATIONS:
None at this time.


DRA: Cardiovascular Disease
DRE: Technology Development and Assessment, Treatment - Comparative Effectiveness
Keywords: Adherence, Medication Management
MeSH Terms: none