scholarly journals Adherence to medication in the community: Audit cycle of interventions to improve the assessment of adherence

2017 ◽  
Vol 41 (1) ◽  
pp. 41-44
Author(s):  
Saeed Farooq ◽  
Abid Choudry
Keyword(s):  
Medication Adherence ◽  
Text Messaging ◽  
Clinical Implications ◽  
Clinical Notes ◽  
Medication Side Effects ◽  
Adherence To Medication ◽  
Retrospective Audit ◽  
Medication Side ◽  
Regular Training

Aims and methodTo investigate whether medication adherence is monitored during follow-up in out-patient reviews. A retrospective audit was carried out with a sample of 50 follow-up patients with a diagnosis of schizophrenia or schizoaffective disorder. Following this, interventions were made prior to the re-audit (including text messaging clinicians and prompt sheets in the out-patient department to encourage adherence discussions).ResultsThere was an improvement on all the standards set for this audit following the interventions. More doctors had discussed medication adherence (62% second cycle v. 50% first cycle) with their patient and there was increased discussion and documentation regarding medication side-effects (60% second cycle v. 30% first cycle). More clinicians discussed the response to medication (60% second cycle v. 46% first cycle).Clinical implicationsTreatment adherence is not regularly monitored or recorded in clinical notes in routine psychiatric out-patient appointments. This highlights the need for regular training to improve practice.

Patterns of drug therapy, glycemic control, and predictors of escalation – non-escalation of treatment among diabetes outpatients at a tertiary care center

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Shubham Atal ◽  
Rajnish Joshi ◽  
Saurav Misra ◽  
Zeenat Fatima ◽  
Swati Sharma ◽  
...  
Keyword(s):  
Drug Therapy ◽  
Medication Adherence ◽  
Glycemic Control ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center ◽  
Clinical Predictors ◽  
Antidiabetic Therapy ◽  
Adherence To Medication

Abstract Objectives The study was conducted to assess patterns of prescribed drug therapy and clinical predictors of need for therapy escalation in outpatients with diabetes mellitus (DM). Methods This was a prospective cohort study, conducted at an apex tertiary care teaching hospital in central India for a period of 18 months. The demographic, clinical, and treatment details on the baseline and follow up visits were collected from the patients’ prescription charts. Glycemic control, adherence, pill burdens along with pattern of antidiabetic therapy escalation, and deescalations were analyzed. Results A total of 1,711 prescriptions of 925 patients of diabetes with a mean age of 53.81 ± 10.42 years and duration of disease of 9.15 ± 6.3 years were analyzed. Approximately half of the patients (n=450) came for ≥1 follow up visits. Hypertension (59.35%) was the most common comorbidity followed by dyslipidemia and hypothyroidism. The mean total daily drugs and pills per prescription were 4.03 ± 1.71 and 4.17 ± 1.38, respectively. Metformin (30.42%) followed by sulphonylureas (SUs) (21.39%) constituted majority of the AHA’s and dual and triple drug therapy regimens were most commonly prescribed. There were improvements in HbA1c, fasting/postprandial/random blood sugar (FBS/PPBS/RBS) as well as adherence to medication, diet, and exercise in the follow up visits. Among patients with follow ups, therapy escalations were found in 31.11% patients, among whom dose was increased in 12.44% and drug was added in 17.28%. Apart from Hb1Ac, FBS, and PPBS levels (p<0.001), characteristics such as age, BMI, duration of diagnosed diabetes, presence of hypertension and dyslipidemia, and daily pill burdens were found to be significantly higher in the therapy escalation group (p<0.05). Inadequate medication adherence increased the relative risk (RR) of therapy escalation by almost two times. Conclusions Disease and therapy patterns are reflective of diabetes care as expected at a tertiary care center. Higher BMI, age, pill burden, duration of diabetes, presence of comorbidities, and poor medication adherence may be the predictors of therapy escalation independent of glycemic control and such patients should be more closely monitored.

scholarly journals The Ready to Reduce Risk (3R) Study for a Group Educational Intervention With Telephone and Text Messaging Support to Improve Medication Adherence for the Primary Prevention of Cardiovascular Disease: Protocol for a Randomized Controlled Trial (Preprint)

2018 ◽  
Author(s):  
Jo L Byrne ◽  
Helen M Dallosso ◽  
Stephen Rogers ◽  
Laura J Gray ◽  
Ghazala Waheed ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Randomized Controlled Trial ◽  
Medication Adherence ◽  
Primary Prevention ◽  
Text Messaging ◽  
Controlled Trial ◽  
Improve Medication Adherence ◽  
Randomized Controlled ◽  
Prevention Of Cardiovascular Disease

BACKGROUND Poor adherence to cardiovascular medications is associated with worse clinical outcomes. Evidence for effective education interventions that address medication adherence for the primary prevention of cardiovascular disease is lacking. The Ready to Reduce Risk (3R) study aims to investigate whether a complex intervention, involving group education plus telephone and text messaging follow-up support, can improve medication adherence and reduce cardiovascular risk. OBJECTIVE This protocol paper details the design and rationale for the development of the 3R intervention and the study methods used. METHODS This is an open and pragmatic randomized controlled trial with 12 months of follow-up. We recruited participants from primary care and randomly assigned them at a 1:1 frequency, stratified by sex and age, to either a control group (usual care from a general practitioner) or an intervention group involving 2 facilitated group education sessions with telephone and text messaging follow-up support, with a theoretical underpinning and using recognized behavioral change techniques. The primary outcome was medication adherence to statins. The primary measure was an objective, novel, urine-based biochemical measure of medication adherence. We also used the 8-item Morisky Medication Adherence Scale to assess medication adherence. Secondary outcomes were changes in total cholesterol, blood pressure, high-density lipoprotein, total cholesterol to high-density lipoprotein ratio, body mass index, waist to hip ratio, waist circumference, smoking behavior, physical activity, fruit and vegetable intake, patient activation level, quality of life, health status, health and medication beliefs, and overall cardiovascular disease risk score. We also considered process outcomes relating to acceptability and feasibility of the 3R intervention. RESULTS We recruited 212 participants between May 2015 and March 2017. The 12-month follow-up data collection clinics were completed in April 2018, and data analysis will commence once all study data have been collected and verified. CONCLUSIONS This study will identify a potentially clinically useful and effective educational intervention for the primary prevention of cardiovascular disease. Medication adherence to statins is being assessed using a novel urine assay as an objective measure, in conjunction with other validated measures. CLINICALTRIAL International Standard Randomized Controlled Trial Number ISRCTN16863160; http://www.isrctn.com/ISRCTN16863160 (Archived by WebCite at http://www.webcitation.org/734PqfdQw) INTERNATIONAL REGISTERED REPOR DERR1-10.2196/11289

scholarly journals Efficacy of Text Messaging and Personal Consultation by Pharmacy Students Among Adults With Hypertension: Randomized Controlled Trial (Preprint)

2019 ◽  
Author(s):  
Panpan Zhai ◽  
Khezar Hayat ◽  
Wenjing Ji ◽  
Qian Li ◽  
Li Shi ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Text Messaging ◽  
Controlled Trial ◽  
Intervention Group ◽  
Text Messages ◽  
Chinese Patients ◽  
Control Group ◽  
To Receive ◽  
Sms Text Messaging

BACKGROUND Hypertension is one of the leading risk factors for ischemic heart diseases, and high rates of hypertension prevalence have either remained the same or increased in developing countries in recent years. Unfortunately, about 20% to 50% of patients with chronic diseases have been nonadherent to their drug therapy. SMS text messaging and pharmacy student–led consultations have the potential to help patients manage their blood pressure (BP). OBJECTIVE The aim of this study was to assess the effectiveness, feasibility, and acceptability of SMS text messaging and consultation to manage the BP of Chinese patients with hypertension. METHODS We conducted a two-arm cluster randomized controlled trial among patients with hypertension in Xi’an City, Shaanxi Province, China, and recruited 384 patients from 8 community health care centers. Patients were randomized into an intervention group to receive SMS text messages and consultations or into a control group to receive usual care for 3 months. We sent SMS text messages at 3-day intervals and collected data at baseline (including demographics, clinical outcomes, medication complexity, side effects, patient behavior, knowledge about hypertension, BP, and medication adherence) and the 3-month follow-up (including BP, medication adherence, and knowledge about hypertension). RESULTS We assessed 445 patients with hypertension and excluded 61 patients who were not eligible or who had not filled out their questionnaires. The mean age of the patients was 68.5 (SD 7.9) years in the intervention group and 69.4 (SD 9.7) years in the control group, and the sample was primarily female (265/384, 69.0%). Patients in the intervention group showed significant improvements in systolic BP (SBP; mean 134.5 mm Hg, SD 15.5 mm Hg vs mean 140.7 mm Hg, SD 15.2 mm Hg; <i>P</i>=.001), medication adherence (mean 7.4, SD 1.2 vs mean 7.0, SD 1.3; <i>P</i>=.04), and knowledge about hypertension (mean 6.3, SD 0.9 vs mean 5.9, SD 1.2; <i>P</i>=.004) compared with those in the control group. In measures of diastolic BP (DBP), the two arms showed nonsignificant improvements (mean 78.2 mm Hg, SD 9.0 mm Hg vs mean 77.2 mm Hg, SD 10.3 mm Hg; <i>P</i>=.06). In total, 176 patients had controlled BP at the 3-month follow-up (98 patients in the intervention group vs 78 patients in the control group), but it was nonsignificant (<i>P</i>=.08). CONCLUSIONS The use of SMS text messaging and consultation to manage SBP and improve medication adherence is effective, feasible, and acceptable among Chinese patients with hypertension, although a significant difference was not observed with regard to DBP. It is important to maximize the potential of SMS text messaging and consultation by increasing the feasibility and acceptance of mobile interventions and conduct a cost-effectiveness analysis on this method. CLINICALTRIAL Chinese Clinical Trial Registry ChiCTR1900026862; http://www.chictr.org.cn/showproj.aspx?proj=42717.

scholarly journals Impact of a Pharmacy-Led Transition of Care Service on Post-Discharge Medication Adherence

Pharmacy ◽  
2019 ◽  
Vol 7 (3) ◽  
pp. 128
Author(s):  
Alaina Stroud ◽  
Georges Adunlin ◽  
Jessica W. Skelley
Keyword(s):  
Medication Adherence ◽  
Transitional Care ◽  
Care Service ◽  
Hospital Environment ◽  
Phone Call ◽  
Transition Of Care ◽  
Management Service ◽  
Adherence To Medication ◽  
Discharge Medication

This study assesses the effectiveness of a pharmacy-led transition of care (TOC) service on increasing patients’ understanding of, and reported adherence to, medication post hospital discharge. A cross-sectional survey was administered to patients who were discharged from the hospital with at least one medication received via bedside delivery from the TOC service. Adherence was assessed by asking the patient if they had taken their discharge medications as instructed by the prescriber. Satisfaction with the discharge medication counseling service was assessed through a five-point Likert scale. Descriptive statistics were conducted for all questionnaire items and qualitative data was examined using content analysis. The majority of patients (73%) were counseled on their medication(s) before leaving the hospital. Among those who received counseling, 76 patients had a better understanding of their medication(s). Ninety-five percent of the patients reported adherence, and all six of the patients reporting non-adherence claimed they were not counseled on their medications prior to discharge. Many patients had questions regarding their medication during the follow-up phone call, substantiating the need for further follow-up with patients once they have left the hospital environment. The implementation of medication bedside delivery and counseling services, followed by outpatient adherence monitoring via a transitional care management service, can result in higher levels of reported medication adherence.

Exploring Barriers to Medication Adherence Among African American Emerging Adults With Uncontrolled Asthma

2021 ◽  
pp. 109019812110013
Author(s):  
Karen Kolmodin MacDonell ◽  
Rhonda Dailey ◽  
Wanda Gibson-Scipio ◽  
Bo Wang ◽  
Veronica Dinaj-Koci ◽  
...  
Keyword(s):  
African American ◽  
Medication Adherence ◽  
Emerging Adults ◽  
Asthma Control ◽  
Text Messaging ◽  
Persistent Asthma ◽  
Poor Adherence ◽  
Daily Diaries ◽  
Asthma Symptoms ◽  
Adherence To Medication

African American emerging adults (age 18–29 years) tend to have poor asthma outcomes, possibly due to poor adherence to medication. Few studies have explored barriers to controller adherence in this population. This study utilized electronic daily diaries to assess barriers to adherence and asthma symptoms among 141 African American emerging adults with uncontrolled persistent asthma and poor adherence. Participants reported symptoms M = 3.43 days (of 7 days). They reported unintentional (e.g., forgetting) and intentional (e.g., choosing not to take) barriers to adherence, but forgetting, being too busy, and sleeping through a dose were the most common. Significant correlations were found between symptoms and barriers, as well as asthma control and medication adherence in the expected directions. Asthma symptoms and number of barriers were significant predictors of asthma control. Existing intervention strategies such as text-messaging may prove effective to address these barriers, but measuring and addressing adherence remains complex.

Factors associated with re-presentation to emergency departments in elderly people with pain

2014 ◽  
Vol 38 (4) ◽  
pp. 461 ◽  
Author(s):  
Rebecca Howard ◽  
Andrew Hannaford ◽  
Tracey Weiland
Keyword(s):  
Risk Factors ◽  
Elderly People ◽  
Opioid Analgesics ◽  
Complex Care ◽  
Care Needs ◽  
Factors Associated ◽  
Medication Side Effects ◽  
Medication Side ◽  
Complex Care Needs

Objectives To identify medical, social and demographic factors associated with increased risk of 30-day re-presentation to the emergency department (ED) in elderly people presenting with pain. Methods We undertook a single site, prospective observational study of all patients aged >65 years discharged from the ED with pain. Data were collected on possible medical, social and demographic predictors of ED readmission. Participants were a subset of all elderly patients presenting to the ED with pain, and received follow-up case management as part of the hospital’s rapid response, assessment and care planning program for elderly people. Results Over 8 months, 356 people were eligible for inclusion in the study; of these, 189 consented to case management and to participate in the study. Three factors statistically increased odds of re-presentation to ED within 30 days: (1) prescription of opioids (P = 0.003); (2) the presence of Home and Community Care Services (P = 0.03); and (3) the absence of a gait aid (P = 0.019). Nineteen per cent of eligible patients re-presented to ED within 30 days of initial presentation. Conclusion These findings contribute to current debate about opioid prescription and effective pain management in the elderly. The study highlights the need for routine follow-up care of older people discharged from the ED with pain, particularly those discharged home with opioids or with complex care needs. What is known about the topic? Re-presentation rates within 28 days for all-comers to the emergency department (ED) are collected and reported as part of routine service monitoring and evaluation. Presentation rates for elderly people to EDs have been escalating over the past decade; however, the risk factors that lead to re-presentations for elderly people have not been documented. Similarly, increasing concern about the prescription of opioids in elderly people is documented; however, its impact on ED re-presentations has not been reported. Innovative models of care are emerging to stem the rise in ED demand; however, their role and impact on re-presentation rates are not documented for this subgroup of ED presenters. What does this paper add? This research has demonstrated that ED re-presentation rates for elderly people with pain are higher than overall ED re-presentation rates. This article has identified three risk factors that significantly increase the risk of re-presentation in this population, including the prescription of opioid analgesics. Qualitative data have identified that elderly people prescribed opioids require extensive education and support to manage the medication side effects. What are the implications for practitioners? Practitioners should be aware that elderly people with pain are a higher risk group for ED re-presentation, particularly those prescribed opioid analgesics or with complex care needs. Discharge planning and assessment of supports should be routinely instigated to manage medication side effects, and follow-up services put in place where inadequate. Improved provision of written information in multiple languages for patients who cannot read English should also be initiated.

Attitudes Toward Antipsychotic Medication, Insight and Psychopathology in Outpatients with Schizophrenia

Folia Medica ◽  
2012 ◽  
Vol 54 (4) ◽  
pp. 62-68 ◽  
Author(s):  
Iglika V. Vassileva ◽  
Vihra K. Milanova
Keyword(s):  
Medication Adherence ◽  
Side Effects ◽  
Antipsychotic Medication ◽  
Rating Scales ◽  
Antipsychotic Treatment ◽  
Negative Attitudes ◽  
Clinical Interviews ◽  
Medication Side Effects ◽  
Positive Attitudes ◽  
Medication Side

Abstract OBJECTIVE: Attitude toward antipsychotic medication is considered as one of the main predictors for medication adherence in schizophrenia. The present non-interventional crosssectional study aims to explore the associations between attitudes toward antipsychotic medication, insight and other clinical variables in outpatients with schizophrenia. METHOD: Attitudes toward antipsychotic medication, clinical and social variables, sociodemographic and illness-related characteristics were assessed via a set of semi-structured clinical interviews and self-rating scales in a total of 226 patients with schizophrenia on a long-term antipsychotic treatment in community based settings. The associations between attitudes toward medication and severity of psychopathology, insight and medication side effects were examined. RESULTS: The greater hospitalization rate in the previous year was associated with more severe psychopathology at the time of the study, more pronounced side effects of the therapy and lack of insight. The lack of insight, the presence of more severe negative and depressive symptoms and disease duration less than 5 years correlated significantly with negative attitudes toward antipsychotic medication. The severity of medication side effects was not associated with the drug attitudes. CONCLUSION: Psychoeducational and psychotherapeutical interventions, along with pharmacotherapy, can be beneficial in forming positive attitudes toward medication and improving medication adherence in schizophrenia, especially in patients with a short duration of the disease.

scholarly journals Patient Adherence to Medication within a New Multidisciplinary Thrombosis Service

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 38-38
Author(s):  
Kwadwo Osei Bonsu ◽  
Stephanie W Young ◽  
Tiffany Lee ◽  
Hai V Nguyen ◽  
Rufaro S Chitsike
Keyword(s):  
Patient Satisfaction ◽  
Secondary Education ◽  
Medication Adherence ◽  
Research Funding ◽  
Post Secondary Education ◽  
Anticoagulation Management ◽  
Post Secondary ◽  
Adherence To Medication ◽  
The Impact

BACKGROUND Poor medication adherence puts patients who require thrombosis care at greater risk of complications. Little is known about the impact of multidisciplinary care models on medication adherence in patients requiring anticoagulation management. It is also unclear from the literature whether adherence varies in clinical practice with the advent of direct oral anticoagulants (DOACs) which have shorter half-lives and require limited or no laboratory monitoring compared to vitamin-K antagonists. We started a new multidisciplinary Adult Outpatient Thrombosis Service (TS) in October 2017 in a Canadian health authority servicing over 300 000 people. The TS is a comprehensive thrombosis and anticoagulation management program with unique, interrelated clinics providing the spectrum of care required for this patient group. The TS includes an Emergency Thrombosis Clinic for care after an acute episode of venous thromboembolism; Thrombosis Clinics addressing non-urgent thrombosis and anticoagulation questions and follow up; Anticoagulation Management Clinics for long term follow up of patients on anticoagulation; and a Perioperative Anticoagulation Management Clinic for patients on anticoagulation requiring surgery or procedures. The TS is staffed by Pharmacists, a Thrombosis Physician/Hematologist, and Clerical staff. The objective of the survey was to assess self-reported medication adherence of patients within the TS. PATIENTS/METHODS We conducted a cross-sectional survey of patients who were consulted to the TS between October 2017 and May 2019. Eligible patients were mailed an anonymous survey with a cover letter and self-addressed, return stamped envelope. Adherence to medication was assessed using the 12-item validated Adherence to Refills and Medications Scale (ARMS). The ARMS utilizes a 4 point scale (1-4), with the continuous score range of 12 to 48, and lower scores indicating better adherence. Baseline characteristics and patient satisfaction with the TS were evaluated for association with medication adherence. Linear regression analysis was used to examine the associations between patient's characteristics, their satisfaction with TS and medication adherence. RESULTS Of 1058 eligible patients, 563 responded to the survey representing a response rate of 53%. Seventeen were excluded who had more than 6 missing responses to the ARMS items. Out of remaining 546 patients with complete responses 55% (n=297) were on DOACs, 19% (n=102) on warfarin, 5.0% (n=27) on low molecular weight heparin (LMWH), 3.3% (n=18) on antiplatelet therapy and 18% (n=96) were not receiving anticoagulation therapy at the time of completing the survey. Nearly half had taken anticoagulant for 1 to 5 years (47%, n=253) while 28% (n=150) and 25% (n=137) had been on an anticoagulant for less than 1 year and more than 5 years respectively. Most patients (87%, n=475) were 50 years of age or older and half (51%, n=277) were male. About two-thirds (67%, n=360) had at least post-secondary education. The mean score for the ARMS was 13.9 (SD 2.2, range 12 to 25). Most patients (88%, n = 481) reported high adherence to medication (ARMS score = 12-16). In univariate analysis, post-secondary education (β = 0.0052, p = 0.006) and patient satisfaction with the TS (β = 0.0004; p = 0.019) significantly predicted medication adherence among participants. In multivariate analyses education (β = 0.0039, p = 0.048) and duration of anticoagulant use (β = 0.0047, p = 0.0244) were significantly associated with medication adherence. The internal consistency reliability for the ARMS tool was acceptable (Cronbach's alpha = 0.70). CONCLUSIONS Self-reported medication adherence was high (88%) in patients seen at a multidisciplinary TS. Post-secondary education and duration of anticoagulant use were important predictors of medication adherence. Disclosures Young: Sanofi Canada: Honoraria, Research Funding; Bayer: Research Funding; Pfizer: Honoraria. Chitsike:Bayer Canada: Research Funding; Sanofi Canada: Honoraria, Research Funding.

scholarly journals Efficacy of Text Messaging and Personal Consultation by Pharmacy Students Among Adults With Hypertension: Randomized Controlled Trial

10.2196/16019 ◽  
2020 ◽  
Vol 22 (5) ◽  
pp. e16019
Author(s):  
Panpan Zhai ◽  
Khezar Hayat ◽  
Wenjing Ji ◽  
Qian Li ◽  
Li Shi ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Text Messaging ◽  
Controlled Trial ◽  
Intervention Group ◽  
Text Messages ◽  
Chinese Patients ◽  
Control Group ◽  
To Receive ◽  
Sms Text Messaging

Background Hypertension is one of the leading risk factors for ischemic heart diseases, and high rates of hypertension prevalence have either remained the same or increased in developing countries in recent years. Unfortunately, about 20% to 50% of patients with chronic diseases have been nonadherent to their drug therapy. SMS text messaging and pharmacy student–led consultations have the potential to help patients manage their blood pressure (BP). Objective The aim of this study was to assess the effectiveness, feasibility, and acceptability of SMS text messaging and consultation to manage the BP of Chinese patients with hypertension. Methods We conducted a two-arm cluster randomized controlled trial among patients with hypertension in Xi’an City, Shaanxi Province, China, and recruited 384 patients from 8 community health care centers. Patients were randomized into an intervention group to receive SMS text messages and consultations or into a control group to receive usual care for 3 months. We sent SMS text messages at 3-day intervals and collected data at baseline (including demographics, clinical outcomes, medication complexity, side effects, patient behavior, knowledge about hypertension, BP, and medication adherence) and the 3-month follow-up (including BP, medication adherence, and knowledge about hypertension). Results We assessed 445 patients with hypertension and excluded 61 patients who were not eligible or who had not filled out their questionnaires. The mean age of the patients was 68.5 (SD 7.9) years in the intervention group and 69.4 (SD 9.7) years in the control group, and the sample was primarily female (265/384, 69.0%). Patients in the intervention group showed significant improvements in systolic BP (SBP; mean 134.5 mm Hg, SD 15.5 mm Hg vs mean 140.7 mm Hg, SD 15.2 mm Hg; P=.001), medication adherence (mean 7.4, SD 1.2 vs mean 7.0, SD 1.3; P=.04), and knowledge about hypertension (mean 6.3, SD 0.9 vs mean 5.9, SD 1.2; P=.004) compared with those in the control group. In measures of diastolic BP (DBP), the two arms showed nonsignificant improvements (mean 78.2 mm Hg, SD 9.0 mm Hg vs mean 77.2 mm Hg, SD 10.3 mm Hg; P=.06). In total, 176 patients had controlled BP at the 3-month follow-up (98 patients in the intervention group vs 78 patients in the control group), but it was nonsignificant (P=.08). Conclusions The use of SMS text messaging and consultation to manage SBP and improve medication adherence is effective, feasible, and acceptable among Chinese patients with hypertension, although a significant difference was not observed with regard to DBP. It is important to maximize the potential of SMS text messaging and consultation by increasing the feasibility and acceptance of mobile interventions and conduct a cost-effectiveness analysis on this method. Trial Registration Chinese Clinical Trial Registry ChiCTR1900026862; http://www.chictr.org.cn/showproj.aspx?proj=42717.

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