Improving Hypertension Medication Adherence for Older Adults

提高老年人高血压药物的依从性

• 批准号: 10320448
• 负责人: Jeannie Kim Lee
• 金额: $ 64.16万
• 依托单位: UNIVERSITY OF ARIZONA
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-02-26 至 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10320448
• 关键词: Adherence; Adopted; Age; Algorithms; Behavior; Blood Pressure; Blood Pressure Monitors; Brain; Cellular Phone; Cognitive; Competence; Cues; Custom; Databases; Discipline of Nursing; Dose; Education; Effectiveness; Elderly; Enhancement Technology; Ensure; Feedback; Fostering; Funding; Health Care Costs; Healthcare; Heart; Heart failure; High Prevalence; Home Blood Pressure Monitoring; Hypertension; Independent Living; Individual; Individual Differences; Instruction; Intervention; Intervention Studies; Kidney; Label; Measures; Mediation; Monitor; Motivation; Myocardial Infarction; Optics; Outcome; Participant; Pattern; Personal Autonomy; Persons; Pharmaceutical Preparations; Population; Process; Protocols documentation; Quality of life; Randomized; Randomized Controlled Trials; Reporting; Resources; Retina; Risk; Schedule; Self Determination; Self Management; Short-Term Memory; Stroke; Support System; System; Technology; Testing; Time; Translating; Visualization; adverse outcome; base; blood pressure control; blood pressure medication; cardiovascular risk factor; cognitive ability; cognitive change; cognitive function; cognitive process; design; efficacy testing; evidence base; executive function; experience; handheld mobile device; health management; hypertension control; improved; improved outcome; medication compliance; mobile application; optical imaging; preservation; primary outcome; prospective memory; psychologic; secondary outcome; sex; technology development; theories; tool; usability; user-friendly; wireless

PROJECT SUMMARY / ABSTRACT Blood pressure (BP) medications are remarkably effective in reducing adverse outcomes of uncontrolled hypertension, and optimal adherence reduces heart failure, stroke, and myocardial infarction, and maintains cognitive function. Hypertension is especially prevalent in older adults (~67%), but BP mediation benefits are unrealized for many older adults, as nonadherence is ~50%, leading to decreased quality of life and high health care costs ($290 billion/year in US). We developed the theory-based Multifaceted Prospective Memory Intervention (MPMI), which significantly improved older adults' adherence to BP medications, but benefits did not sustain, once nursing support was removed. We thus developed the Medication Education, Decision Support, Reminding, and Monitoring System (MEDSReM) mobile application (App), which changes medication taking from an effortful process dependent on executive functions and cognitive processes that decline with age, to customized, cue-driven associative processes that are mostly preserved with age. MEDSReM-2 will capitalize on technological advances to integrate additional functionalities to MEDSReM including electronic BP monitoring and provide feedback about the relationship between medication adherence and BP. We will test the efficacy of MEDSReM-2, and expect that the evidence-based and multi-dimensional approach will increase perceived competence and autonomy, resulting in higher and sustained medication adherence and improved BP levels for nonadherent older adults (≥ 65 years), who self-manage at least one hypertension medication. The aims are: Aim 1: Advance the design of MEDSReM-2, an integrated mobile application that provides education, decision support, reminders, and monitoring to incorporate feedback on adherence related to BP measures. This aim will include implementing and testing new functionalities (e.g., electronic BP monitoring, optical image capture of labels to self-start the App, expanded decision support), as well as user- tested instructional protocols. Aim 2: Determine the efficacy and scalability of MEDSReM-2 through a randomized controlled trial (RCT) to assess efficacy as well as individual patterns of adherence and system use over time. We will screen 448 older people with hypertension to identify 224 nonadherent, randomized to a 6-month intervention study. The primary outcome will be improved adherence (n=112) versus an education control (n=112). Secondary outcomes will be BP, autonomy and competence, and mobile device proficiency. We will examine change in adherence over time in individual participants and moderators of sustainability, and evaluate MEDSReM-2 use patterns to assess factors related to improved adherence and BP management. Successful completion of these aims will result in a theory-based, technology-enhanced comprehensive self- management system that supports hypertension medication adherence and BP management for older adults. MEDReM-2 will foster self-management, through greater personal autonomy and competence, with potential to reduce hypertension-associated risks, save healthcare dollars, and promote independent living of older adults.

项目摘要 /摘要 血压（BP）药物在减少不受控制的不良后果方面非常有效 高血压和最佳依从性可减少心力衰竭，中风和心肌梗塞，并保持 认知功能。高血压在老年人中尤其普遍（约67％），但BP调解益处是 许多老年人未实现，因为不遵守〜50％，导致生活质量降低和高 医疗保健费用（美国/年为2900亿美元）。我们开发了基于理论的多方面的前瞻性记忆 干预措施（MPMI），显着改善了老年人对BP药物的遵守，但有益 一旦删除了护士支持，就不维持。因此，我们开发了药物教育，决定 支持，提醒和监视系统（MEDSREM）移动应用程序（APP），它更改药物 从有效的过程中取决于行政职能和认知过程，这些过程逐渐下降 年龄，定制的提示驱动的关联过程，这些过程大多随着年龄的增长而保存。 MEDSREM-2将 利用技术进步，将其他功能集成到包括电子在内的MedsRem BP监视并提供有关药物依从性和BP之间关系的反馈。我们将 测试MEDSREM-2的效率，并期望循证和多维方法将 提高感知能力和自主权，从而导致更高和持续的药物依从性和 非护身老年人（≥65岁）的BP水平提高了，他们自我管理至少一种高血压 药物。目的是：目标1：推进MedsRem-2的设计，MedsRem-2，这是一个集成的移动应用程序 提供教育，决策支持，提醒和监视，以纳入有关依从性相关的反馈 进行BP措施。此目标将包括实施和测试新功能（例如电子BP 监视，标签的光学图像捕获以自动启动应用程序，扩展决策支持）以及用户 经过测试的教学协议。目标2：通过A确定MEDSREM-2的效率和可伸缩性 随机对照试验（RCT）评估效率以及依从性和系统的单个模式 随着时间的流逝。我们将筛选448名患有高血压的老年人，以识别224个不遵守者，随机分配给 6个月的干预研究。主要结果将得到改善的依从性（n = 112）与教育 控制（n = 112）。次要结果将是BP，自主权和能力以及移动设备的能力。 我们将研究可持续性的个别参与者和主持人随着时间的推移依从性的变化，以及 评估MEDSREM-2使用模式来评估与改善依从性和BP管理有关的因素。 这些目标的成功完成将导致基于理论，技术增强的综合自我 支持老年人的高血压药物依从性和BP管理的管理系统。 MedRem-2将通过更大的个人自主权和能力来促进自我管理，并有潜力 降低与高血压相关的风险，节省医疗保健资金并促进老年人独立生活。