Uso de mensagens de texto na promoção da adesão medicamentosa e na redução da pressão arterial em pacientes hipertensos: Estudo ESSENCE

Abstract

Introduction: Non-communicable chronic diseases have a great impact on the health system and, among them, systemic arterial hypertension is the most prevalent, being associated with high socioeconomic costs, represented by the high rates of hospitalizations in the Unified Health System (SUS), due to the loss of work productivity and family income. Despite its diagnosis being considered easy and the broad therapeutic arsenal available, effective blood pressure control and maintenance of the therapeutic regimen have been difficult due, among other factors, to non-adherence to treatment. Although several interventions have been developed to improve adherence to medication treatment, no high-quality evidence was found to support the use of a specific intervention. However, recently, studies have shown that sending text messages (Short Message Service - SMS) as reminders or patient engagement messages has increased adherence to the treatment of patients with chronic diseases, requiring, however, to be deepened through other designs. Objective: The ESSENCE study sought to evaluate sending text messages with a reminder of the time to use medication, compared to sending informative messages, on adherence to medication treatment and on blood pressure in patients with hypertension. Methods: This prospective, randomized, crossover, double-blind study included hypertensive patients, aged between 30 and 69 years, followed at a community pharmacy. Group 1 included 77 patients who received informational text messages about antihypertensives and hypertension control for 90 days via cell phones. Group 2 included 80 patients who received the informational messages plus reminder messages at the time of each drug dose for 90 days. After a 30-day washout period, the groups were switched and received the interventions for another 90 days. Results: The 157 individuals evaluated had a mean age of 52(8.8) years and the majority were female (76.4%). No significant difference was found in intra- and inter-group self-reported adherence. For systolic and diastolic blood pressure, there was a significant reduction during the first phase of the study, but with no difference when comparing groups. For the second phase, the reduction was not significant in the intragroup analyses, however, at the end of the study, there was a significantly greater reduction in BP in group 1 when comparing the groups. Conclusion: It was observed an equivalence of effect between the two interventions for the primary outcomes evaluated. The results point to the possibility of implementing messaging systems in health services.