A successful intervention to improve medication adherence in Black patients with hypertension: Mediation analysis of 28-site TEAM trial.
A successful intervention to improve medication adherence in Black patients with hypertension: Mediation analysis of 28-site TEAM trial.
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DOI：
10.1016/j.japh.2022.01.002
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发表时间：
2022-05
影响因子：
2.1
通讯作者：
Shireman, Theresa I.
中科院分区：
文献类型：
--
作者：
Svarstad, Bonnie L.;Brown, Roger L.;Shireman, Theresa I.
我们先前报道了一个成功的多方面团队教育和依从性监测（TEAM）干预的主要效果和成本效益，以提高黑人高血压患者的再灌注依从性。重要的是要确定关键介质或干预组件，有助于这种干预效果。本研究旨在进行“中介分析”，以确定哪些干预成分对续药依从性的影响最大，并评估患者对药房护理的满意度。在28家药店（14家TEAM，14家对照）的576名黑人患者中进行了一项整群随机试验。TEAM参与者被邀请与药剂师-技术人员团队一起进行6次访问，该团队监测患者的血压，并使用9项简要药物调查问卷，简要目标检查和其他新工具来识别和减少黑人患者的依从性障碍。对照组受试者仅收到打印信息。再填依从性定义为在7至12个月（干预后）期间每个再填记录覆盖的天数（覆盖天数的比例）> 80%;使用第6个月的研究问卷评估潜在介质和患者满意度。一个结构性概率单位模型检查了4种可能解释干预成功的潜在介质。在4种潜在介质中，解释再填充依从性（干预后）改善的最重要因素是药剂师与患者在屏障降低方面的更多合作（总间接效应的68.5%）和患者使用药盒（总间接效应的27.2%）。药剂师与医生的联系和改变方案的建议对依从性没有显著影响。TEAM参与者比对照组参与者更可能将他们的药剂师护理评为“非常满意”（80.2%对44.2%，P < 0.001）和技术人员护理评为“非常满意”（81.2%对47.4%，P < 0.001）。通过实施具有新颖工具的协作团队模型，使社区药剂师和技术人员能够帮助识别和减少依从性的核心障碍，可以提高黑人高血压患者的再填充依从性和满意度。我们的研究结果可用于个性化和改善患者护理和依从性的结果，在这个脆弱的人群。
We previously reported the main effects and cost-effectiveness of a successful multifaceted Team Education and Adherence Monitoring (TEAM) intervention to improve refill adherence in black patients with hypertension. It is important to identify the key mediators or intervention components that contributed to this intervention effect. This study aimed to conduct a “mediation analysis” to determine which intervention components had the largest effect on refill adherence and assess patient satisfaction with pharmacy care. A cluster-randomized trial was conducted among 576 black patients in 28 pharmacies (14 TEAM, 14 control). TEAM participants were invited to 6 visits with a pharmacist-technician team that monitored the patient’s blood pressure and used a 9-item Brief Medication Questionnaire, Brief Goal Check, and other novel tools to identify and reduce barriers to adherence in black patients. Control participants received printed information only. Refill adherence was defined as > 80% days covered (proportion of days covered) per refill records during months 7 to 12 (postintervention); potential mediators and patient satisfaction were assessed using a research questionnaire administered at month 6. A structural probit model examined 4 potential mediators that might explain intervention success. Of 4 potential mediators, the most important factors in explaining the improvement in refill adherence (postintervention) were greater pharmacist collaboration with patient in barrier reduction (68.5% of total indirect effect) and patient use of a pillbox (27.2% of total indirect effect). Pharmacist contact with physician and suggestion of a change in regimen did not have significant effects on adherence. TEAM participants were more likely than control participants to rate their pharmacist care as “very satisfactory” (80.2% vs. 44.2%, P < 0.001) and technician care as “very satisfactory” (81.2% vs. 47.4%, P < 0.001). Refill adherence and satisfaction can be improved in black patients with hypertension by implementing a collaborative TEAM model with novel tools that enable community pharmacists and technicians to help identify and reduce the core barriers to adherence. Our results can be used to individualize and improve patient care and adherence outcomes in this vulnerable population.
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DOI：
10.1111/jch.13089
发表时间：
2017-10
期刊：
Journal of clinical hypertension (Greenwich, Conn.)
影响因子：
--
作者：
Ferdinand KC;Yadav K;Nasser SA;Clayton-Jeter HD;Lewin J;Cryer DR;Senatore FF
通讯作者：
Senatore FF
影响因子：
6.3
作者：
Holmes HM;Luo R;Hanlon JT;Elting LS;Suarez-Almazor M;Goodwin JS
通讯作者：
Goodwin JS
影响因子：
2.9
作者：
Poon, Ivy;Lal, Lincy S.;Braun, Ursula K.
通讯作者：
Braun, Ursula K.
影响因子：
3.3
作者：
Shaya, Fadia T.;Du, Dongyi;Weir, Matthew R.
通讯作者：
Weir, Matthew R.
影响因子：
5.4
作者：
Chang TJ;Bridges JFP;Bynum M;Jackson JW;Joseph JJ;Fischer MA;Lu B;Donneyong MM
通讯作者：
Donneyong MM