![]() ![]() I only have a vague idea of what I want to do after college. In addition, we will assess the context and implementation processes to inform local tailoring, adaptations and modifications, and eventual expansion of the intervention within the 3 HCS more broadly and nationally (Aim 4).As part of my internship, my supervisor is having me do some career exploration. We will also evaluate the intervention using a mixed methods approach and applying the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework. Secondary outcomes will include intermediate clinical measures (e.g., BP control), CV clinical events (e.g., hospitalizations), healthcare utilization, and costs (Aim 3). The primary outcome will be medication adherence defined by the proportion of days covered (PDC) using pharmacy refill data. We seek to apply our findings from the UG3 Phase/Year 1 study to accomplish two additional aims in Years 2-5 (UH3): Conduct a pragmatic patient-level randomized intervention across 3 HCS to improve adherence to chronic CV medications. We will also leverage pharmacy refill data to identify episodes of non-adherence through gaps in medication refills and randomize individuals to 1 of 4 study arms when they have a first refill gap: 1) usual care 2) generic text message reminder 3) tailored and engaging text messages optimized to facilitate behavior change or 4) optimized text messages plus a pre-programmed AI interactive chat bot designed to support identification and resolution of barriers to medication refill and adherence. To accomplish Aim 2, our study team will identify patients with chronic cardiovascular (CV) conditions taking medications to treat hypertension, atrial fibrillation, coronary artery disease, diabetes and/or hyperlipidemia. During the process, we will also engage patient, provider and health systems stakeholders in designing, refining, and implementing the pilot intervention. Secondly, applying our findings from Aim 1, we aim to conduct a pilot intervention to demonstrate the feasibility of delivering the nudge messages and their preliminary effects in all 3 HCS (Aim 2). In the UG3 Phase, we aim to develop and program a theoretically-informed, technology-based (a) nudge message library and (b) chat bot content library using multiple and iterative N of 1 within-subject studies to optimize content for a range of diverse patients (Aim 1). In the UG3 Phase of our study, we aim to develop the necessary infrastructure and to pilot the nudge trial in preparation for the implementation of a pragmatic, patient-level randomized intervention across 3 HCS (UH3 Phase/Years 2-5). Our objective is to employ population-level pharmacy data and to deliver nudges via cell phone text messaging and artificially intelligent (AI) interactive chat bot to improve medication adherence and patient outcomes in 3 integrated healthcare delivery systems (HCS): University of Colorado Health System (UCHealth), VA Eastern Colorado Health Care System (VA), and Denver Health Medical Center (DH). Mobile and digital technologies for health promotion and disease self-management offer an untested opportunity to adapt behavioral ‘nudges’ using ubiquitous cell phone technology to facilitate medication adherence. Interventions to improve adherence - such as patient education, reminders, pharmacist support, and financial incentives - have produced inconsistent results due to limited study designs. Up to 50% of patients do not take their cardiovascular medications as prescribed, resulting in increased morbidity, mortality, and healthcare costs. ![]()
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