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Remote Cognitive Adaptation Training to improve medication follow through in managed care (R-CAT)

远程认知适应培训可改善管理式护理中的药物跟踪 (R-CAT)

基本信息

批准号：
10209187
负责人：
Dawn Irene Velligan
金额：
$ 76.73万
依托单位：
UNIVERSITY OF TEXAS HLTH SCIENCE CENTER
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-09-01 至 2023-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10209187
关键词：
Adaptive Behaviors Adherence Aftercare Attention Awareness Behavior Behavioral Bypass Chronic Chronic Disease Clinical Cognitive Conscious Cues Custom Data Direct Costs Emergency department visit Emergency medical service Goals Habits Health Health Promotion Home environment Home visitation Hospital Costs Hospitalization Impairment Individual Intention Intervention Lead Maintenance Managed Care Measures Mediation Medical Medical Care Costs Memory Modeling Motivation Outcome Patient Self-Report Persons Pharmaceutical Preparations Population Prevention Prize Problem Solving Process Public Health Randomized Regimen Resources Risk Risk Factors Rural Community Series Services Symptoms Technology Telephone Testing Text Text Messaging Time Training Transportation Visit Work World Health Organization base care costs compliance behavior cost design distraction effectiveness testing evidence base experience follow-up forgetting hospital services improved improved outcome indexing medication compliance member modifiable risk pill psychosocial repetitive behavior response rural setting service utilization severe mental illness standard care symptomatology theories treatment as usual treatment effect

项目摘要

Project Summary/Abstract Poor adherence to prescribed medications is a major public health problem across chronic illness such as severe mental illness (SMI), leads to increased risk of hospitalizations, costs up to $300 billion annually and is arguably one of the most important modifiable risk factors leading to poor outcomes. According to the World Health Organization, increasing adherence may have a greater effect on health than any improvement in specific medical treatments. We propose to test a remotely delivered version of Cognitive Adaptation Training (R-CAT) which uses environmental supports to bypass many of the problems people have in following through with medication even when they think it is the right thing to do for their illness. R-CAT is designed to bypass problems including, forgetting, distraction, problem-solving, motivation, and resources such as limited access to transportation. CAT delivered in person has been found to improve medication follow-though, reduce hospitalizations, and improve outcomes for individuals with SMI. R-CAT was developed to serve a larger number of individuals as well as those in rural settings, and includes individualized medication set up; text reminders; telephone staff to check in and assist in re-filling medication containers; mail-delivered supports (signs, customized pill containers, alarms, checklists), limited in-home visits and a series of participation prizes to improve habit formation and sustain good medication follow-through. We propose to randomize 266 managed care members to R-CAT or Treatment as Usual for 6 months and to follow them for 6 months after treatment ends. Medication follow-through will be assessed using unannounced in-home pill counts and claims data for refills. We will also measure symptoms, service use, and care costs. In addition, we will examine the mechanisms of action of R- CAT. The path model proposes that during treatment repetitive behavior performed at the same time, in the same way, every day in response to R-CAT cues (i.e., taking medication because of cues, alarms, text messages) leads to habit formation, increasing habit strength/automaticity. We propose that habit strength at the end of treatment then predicts maintenance of adherence. Improving adherence to medication may be one of the most important MCO-wide behavioral change targets. If successful, a remote, easy to deliver intervention such as R-CAT in managed care has the potential to improve adherence and outcomes for those with SMI and other chronic medical conditions and to substantially reduce the costs of care.

项目总结/摘要对处方药的依从性差是慢性病的一个主要公共卫生问题，严重精神疾病（SMI）导致住院风险增加，每年花费高达3000亿美元，可以说是导致不良结果的最重要的可改变的风险因素之一。根据世界卫生组织，增加坚持可能有更大的影响健康比任何改善，具体的治疗方法。我们建议测试一个远程交付版本的认知适应训练（R-CAT），它使用环境支持，以绕过许多问题，人们在以下通过与药物，甚至当他们认为这是正确的事情做他们的疾病。R-CAT旨在解决以下问题，遗忘、分心、解决问题、动力和资源，如交通工具有限。已发现亲自交付的CAT可改善药物随访，减少住院，改善SMI患者的预后。R-CAT的开发是为了服务于更多的个人，以及那些在农村环境，并包括个性化的药物设置;短信提醒;电话工作人员，检查并协助重新填充药物容器;邮寄支持（标志、定制药丸容器，警报器，检查表），有限的家庭访问和一系列的参与奖品，以改善习惯形成并保持良好的药物随访。我们建议随机选择266名管理式护理成员治疗结束后随访6个月。药物将使用未经宣布的家庭药丸计数和续装的索赔数据来评估后续情况。我们还将测量症状、服务使用和护理成本。此外，我们还将研究R的作用机制- 目录路径模型提出，在治疗过程中，在同一时间进行的重复行为，同样的方式，每天响应R-CAT提示（即，因为提示、警报、短信而服药信息）导致习惯形成，增加习惯强度/自动性。我们建议，治疗结束则预示着依从性的维持。改善药物依从性可能是其中之一最重要的行为改变目标如果成功，一个远程的，容易交付的管理式护理中的R-CAT等干预措施有可能改善这些患者的依从性和结局重度精神病患者和其他慢性疾病患者的治疗，并大幅降低护理成本。