고혈압 환자에서 순응도 개선을 위한 단기간의 휴대전화 문자메시지의 효과 = The Effectiveness of Short Term Mobile Phone Text Reminders in Improving Compliance among Hypertensive Patients

다국어 초록 (Multilingual Abstract)

Background: For the effective management of hypertension, drug adherence and life style modification areimportant. We investigated the effects of mobile phone text‐message reminders on compliance and life stylemodification in patients with hypertension.
Methods: The study was performed at family medicine outpatient clinics at 15 hospitals in South Korea fromJuly 2008 to June 2010. Study subjects included 1,449 patients who were all prescribed candesartan cilexetil.
Patients were randomly divided into two groups‐ mobile phone text‐message reminder group and control group.
In the reminder group, contents of text messages were recommendations for antihypertensive adherence, exercise,low salt diet, and reduction of weight and alcohol. In the control group, the date of next visit was sent at10 week. Mobile phone text-messages were sent at 2, 4, 6, 8 and 10 weeks by the coordinating center.
Thereafter, they were followed up for 12 weeks. Chi-square test was performed to compare compliance and performanceindexes of the two groups.
Results: The reminder group had 719 (49.6%) patients vs. 730 (50.4%) patients in the control group. Attendancerate were 92.8% for the reminder group and 94.7% for the control group (P=0.14). 94.7% of the reminder group and94.0% of the control group took their medication regularly (P=0.59). The target blood pressure was attained in75.8% of the reminder group and 75.4% of the control group (P=0.87). Similarly, rates of weight loss, decreased alcoholuse, increased physical activity and a low salt diet showed no significant differences between the two groups.
Conclusions: In our study, mobile phone text reminders did not show to have any significant positive effect onthe management of hypertension.

국문 초록 (Abstract)

배경: 고혈압 진료에 있어서 혈압 관리 및 치료에 관한내용을 담은 개인 휴대전화 문자메시지를 이용하는 것이고혈압 환자의 순응도 및 생활 습관을 포함한 성과지표개선에 영향을 미치는지 알아보고자 연구를 시작하였다.
방법: 연구기간은 2008년 7월부터 2010년 6월까지이며이 기간 동안 동일한 칸데살탄 제제의 항고혈압약물을 처음 처방받은 사람 중 개인 휴대전화 메시지 발송에 동의한 사람 1,453명(남자 607명(47.8%), 여자 846명(58.2%))을 대상으로 하였다. 총 관찰 기간은 12주로 하였고 등록후 문자메시지는 2주에 1회, 총 5회(2, 4, 6, 8, 10주)에 걸쳐 조정센터에서 연구자 맹검을 위해 연구자별로 무작위 배정하여 발송하였다(메시지 발송군: 719명(49.6%): 남자 309명, 여자 410명/대조군: 730명(50.4%): 남 296명, 여 434명).
문자메시지는 항고혈압약물 복용, 운동, 저염식, 절주, 체중감량을 권유하는 내용이었고, 대조군의 경우 10주에 차기 방문 일자만 알려주는 문자메시지를 발송하였다. 연구시작 12주 후 조사군의 외래 방문율, 항고혈압약물 복용률, 혈압 조절률, 체중감소율, 음주량 감소율, 신체활동도증가율, 염분섭취 감소율을 확인하고 이를 대조군과 비교하였다. 두 집단 간 성과지표는 카이제곱검정으로 비교하였고 유의수준은 0.05를 기준으로 하였다. 모든 통계분석은 SAS 9.1을 이용하였다.
결과: 방문율의 경우 조사군이 92.8%, 대조군은 94.7%(P=0.140)로 두 군 간에 유의한 차이가 없었다. 항고혈압약물 복용률도 조사군 94.7%, 대조군 94.0% (P=0.590)로유의한 차이가 없었다. 혈압 조절률, 3% 이상의 체중감소율, 음주량 감소율, 신체활동도 증가율, 염분섭취 감소율에서도 의미 있는 차이는 없었다.
결론: 본 연구에서 단기간의 휴대전화 문자메시지 사용은 고혈압 환자의 순응도 개선 및 성과 지표 향상에 영향을 주지 못하였다.

참고문헌 (Reference)

1 오지연, "한국어판 단문형 국제신처활동설문(IPAQ)의 신뢰도와 타당도" 대한가정의학회 28 (28): 532-541, 2007

2 Egan BM, "US trends in prevalence, awareness, treatment, and control of hypertension, 1988-2008" 303 (303): 2043-2050, 2008

3 Cramer JA, "The significance of compliance and persistence in the treatment of diabetes, hypertension and dyslipidaemia: a review" 62 (62): 76-87, 2008

4 Park KA, "The related factors on medication adherence in elderly patients with hypertension or diabetes mellitus" Kyungpook National University 2010

5 Korean Statistical Information Center, "The number of mobile phone subscriptions"

6 Touchette DR, "Survey of medication therapy management programs under Medicare Part D" 46 (46): 683-691, 2006

7 Lenfant C, "Seventh report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7): resetting the hypertension sails" 107 : 2993-2994, 2003

8 Gohar F, "Selfcare and adherence to medication: a survey in the hypertension outpatient clinic" 8 : 4-, 2008

9 Kim HJ, "Salt usage behaviors are related to urinary sodium excretion in normotensive Korean adults" 16 (16): 122-127, 2007

10 WHO, "Prevention of cardiovascular disease: guidelines for assessment and management of cardiovascular risk" World Health Organization(WHO)

11 DiMatteo MR, "Patient adherence and Medical treatment outcomes: a meta-analysis" 40 (40): 794-811, 2002

12 Ministry of Health and Welfare, "National Health Plan 2020"

13 Pop-Eleches C, "Mobile phone technologies improve adherence to antiretroviral treatment in a resourcelimited setting: a randomized controlled trial of text message reminders" 25 (25): 825-834, 2011

14 Grant RW, "Medication adherence before an increase in antihypertensive therapy: a cohort study using pharmacy claims data" 27 (27): 773-781, 2005

15 Korea Centers for Disease Control and Prevention, "Korea Health Statistics 2010: Korea National Health and Nutrition Examination Survey (KNHANES V-1)"

16 Dick JJ, "Feasibility and usability of a text message-based program for diabetes self-management in an urban African-American population" 5 (5): 1246-1254, 2011

17 Hussein WI, "Effectiveness of mobile phone short message service on diabetes mellitus management;the SMS-DM study" 94 (94): e24-e26, 2011

18 Márquez Contreras E, "Effectiveness of an intervention to provide information to patients with hypertension as short text messages and reminders sent to theirmobile phone (HTA-Alert)" 34 (34): 399-405, 2004

19 Chen Z, "Comparison of an SMS text messaging and phone reminder to improve attendance at a health promotion center: a randomized controlled trial" 9 (9): 34-38, 2008

20 Egan BM, "Awareness, knowledge, and attitudes of older Americans about high blood pressure: implications for health care policy, education, and research" 163 (163): 681-687, 2003

21 Park JH, "Antihypertensive drug medication adherence of national health insurance beneficiaries and its affecting factors in Korea" Seoul National University 2006

22 Viswanathan H, "An inquiry into medication meanings, illness, medication use, and the transformative potential of chronic illness among African Americans with hypertension" 1 (1): 21-39, 2005

23 Prospective Studies Collaboration, "Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies" 360 (360): 1903-1913, 2002

24 WHO, "Adherence to long-term therapies: evidence to action" World Health Organization (WHO)

25 Kim HW, "A follow up study for drop-out of hypertensive patients registered in a community hospital" 7 (7): 1-11, 1986

26 Choi NH, "A Study of the Factors influencing the Compliance of Hypertensive Patients to Therapy -Centered on the Registered Patients of Hypertension in a Rural Clinic-" 12 (12): 1-12, 1991

27 The Korean Society of Hypertension, "2004 Korean Hypertension Treatment Guidelines"