The mortality of individuals with bipolar disorder (BD) is approximately double that of the general population and cardiovascular disease accounts for the largest number of deaths. Medication non-adherence among such individuals and its negative impact on both cardiovascular and mental health is a potentially modifiable problem of critical public health importance. This study is intended to simultaneously improve adherence to antihypertensives and medications to treat BD. The proposed two-phased intervention development study written in response to PA-14-335: Advancing Interventions to Improve Medication Adherence, aims to identify attitudes, social influences, and self-efficacy beliefs about adherence to non- psychotropic versus psychotropic medications in hypertensive persons with BD, incorporate the information into a customized interactive m-Health texting intervention built on the Individualized Texting for Adherence Building (iTAB) platform, and test the feasibility, acceptability and effectiveness of the intervention on anti- hypertensive adherence and systolic blood pressure. Phase I of the project will use an iterative process informed by input from Focus Groups to identify barriers and facilitators for antihypertensive adherence compared to mood stabilizers/antipsychotics in patients with BD and hypertension (HTN) using qualitative methods. The results from the focus groups will be integrated into customized m-Health intervention (iTAB-CV) which primes habit formation by targeting behavioral intention using customized psychoeducational and motivational texts with social reference and remediates for prospective memory deficits by providing contextual cues, reminders and immediate positive reinforcement. The goal of iTAB-CV is to create a strong and automatic habit of taking medication which will be sustainable despite variability over time in behavioral intent. The m-Health intervention, iTAB-CV, is intended to improve adherence with medication treatment for antihypertensives and medications for BD and is designed to be implemented in both community mental health centers and primary care settings. Phase II of the project will be a prospective pilot study of iTAB-CV in 38 individuals with BD and hypertension who are non-adherent to at least 20% of prescribed antihypertensive medication. We hypothesize that iTAB-CV will be acceptable to patients with BD and HTN, feasible, and effective in improving adherence to antihypertensives. Secondary outcomes include change in systolic blood pressure, adherence to psychotropic medications, improved psychiatric symptoms, and health status. It is expected that this practical customized intervention will be suitable for implementation in diverse settings and has the potential to reverse the unacceptably high morbidity and mortality seen in individuals with BD.
The proposed project will clarify barriers and facilitators to psychotropic and non-psychotropic medication adherence in individuals with bipolar disorder (BD) and hypertension in order to develop and test a tailored m- Health intervention intended to improve medication adherence in this vulnerable and high risk group. Given the serious negative consequences of uncontrolled hypertension, including early mortality in persons with BD, an intervention that successfully improves adherence to antihypertensives while simultaneously addressing psychiatric medication adherence and which can be administered via text messaging would be of substantial public health benefit. This grant will inform a future rigorous comparative study to test both the effectiveness and mechanism of action of this novel intervention.
| Blixen, Carol; Sajatovic, Martha; Moore, David J et al. (2018) Patient Participation in the Development of a Customized M-Health Intervention to Improve Medication Adherence in Poorly Adherent Individuals with Bipolar Disorder (BD) and Hypertension (HTN). Int J Healthc 4:25-35 |
