Effectiveness of Electronic Reminders to Improve Medication Adherence in Tuberculosis Patients: A Cluster-Randomised Trial

作者：Xiaoqiu Liu, James Lewis, Hui Zhang, Wei Lü, Shun Zhang, Guilan Zheng, Liqiong Bai, Jun Li, Xue Li, Hongguang Chen, Mingming Liu, Rong Chen, Junying Chi, Jian Lu, Shitong Huan, Shiming Cheng, Lixia Wang, Shiwen Jiang, Daniel P. Chin, Katherine Fielding · 发表于：PLoS Medicine · 年份：2015 · DOI：10.1371/journal.pmed.1001876 · 被引用次数：264 · 研究领域：Tuberculosis Research and Epidemiology、Mobile Health and mHealth Applications、Pneumocystis jirovecii pneumonia detection and treatment

BACKGROUND: Mobile text messaging and medication monitors (medication monitor boxes) have the potential to improve adherence to tuberculosis (TB) treatment and reduce the need for directly observed treatment (DOT), but to our knowledge they have not been properly evaluated in TB patients. We assessed the effectiveness of text messaging and medication monitors to improve medication adherence in TB patients. METHODS AND FINDINGS: In a pragmatic cluster-randomised trial, 36 districts/counties (each with at least 300 active pulmonary TB patients registered in 2009) within the provinces of Heilongjiang, Jiangsu, Hunan, and Chongqing, China, were randomised using stratification and restriction to one of four case-management approaches in which patients received reminders via text messages, a medication monitor, combined, or neither (control). Patients in the intervention arms received reminders to take their drugs and reminders for monthly follow-up visits, and the managing doctor was recommended to switch patients with adherence problems to more intensive management or DOT. In all arms, patients took medications out of a medication monitor box, which recorded when the box was opened, but the box gave reminders only in the medication monitor and combined arms. Patients were followed up for 6 mo. The primary endpoint was the percentage of patient-months on TB treatment where at least 20% of doses were missed as measured by pill count and failure to open the medication monitor box. S...