Pharmacist-CHW Team to Improve Medication Adherence and Reduce Hypertension Disparities

摘要 美国在高血压方面面临着深刻的种族和民族差异，这一差异因以下因素而加剧： 药物依从性。然而，现有的药物依从性干预措施很少针对特定的 不同人群的文化信仰，他们也面临着重大的结构性障碍， 贫困、获得护理和粮食不安全。建议与药师一起提高用药依从性 和CHW团队（IMPaCT）的干预响应了为患者量身定制的依从性干预的呼吁。 少数民族的特殊需要。IMPaCT是基于实践的随机对照试验（RCT） 测试一个全面的，个性化的和文化定制的干预措施的有效性， 高血压患者，多药治疗和低依从性。IMPaCT利用了一个 临床药剂师与社区卫生工作者（CHW）一起担任文化经纪人， 患者导航器，以解决个体、临床、社会文化和结构性依从性障碍。这 全面、量身定制、协调的护理干预旨在提高药物依从性， 非裔美国人、拉丁美洲人和越南移民患者的高血压结局。拟议 基于实践的随机对照试验旨在满足以下具体目标： 目标1：实施IMPaCT，这是一种创新的、量身定制的依从性干预措施，由药剂师提供， CHW团队 目标2：通过评估干预前后，确定IMPaCT的短期和长期有效性 变化：a）药物依从性（近端结局）和血压（BP，远端结局），和B） 其他共病健康结果（例如，HbA1c，BMI）。 目标3：确定与IMPaCT有效性相关的因素，包括：a）定制的干预功能，B） 用药信念，c）依从性障碍，d）干预剂量，e）健康素养，和f）文化群体。 我们将遵循意向治疗随机设计，使用等待列表控制450名非洲裔美国人， 拉丁裔和越南高血压患者，药物依从性低（<80%）。数据收集通过 药丸计数，自我报告，电子健康记录和临床措施将评估药物依从性，BP 以及基线（干预前）和干预后4、10和24周的其他因素。IMPaCT是一个 创新的协调护理团队干预，以改善药物依从性和血压 基于现有临床实践的研究成果。设计着眼于可持续性， IMPaCT为药物依从性低的患者提供收费药剂师和CHW服务， 慢性病的高负担和可预防的后果。IMPaCT提供跨专业团队护理， 全面的专业知识和互补的技能组合，减轻专科医学的筒仓效应， 为不同的高血压高危人群提供初级保健。

Abstract The U.S. faces profound racial and ethnic disparities in hypertension, which are exacerbated by disparities in medication adherence. Yet few existing medication adherence interventions are tailored to address the specific cultural beliefs of diverse populations who also face significant structural barriers to adherence associated with poverty, access to care and food insecurity. The proposed Improving Medication Adherence with Pharmacist and CHW Team (IMPaCT) intervention responds to the call for adherence interventions that are tailored for the specific needs of minority racial-ethnic groups. IMPaCT is a practice-based randomized controlled trial (RCT) to test the effectiveness of a comprehensive, individually- and culturally-tailored intervention for high-risk patients with hypertension, polypharmacy and low adherence. IMPaCT leverages the specialized expertise of a clinical pharmacist together with a community health worker (CHW) who will serve as cultural broker and patient navigator to address individual, clinical, social-cultural, and structural barriers to adherence. This comprehensive and tailored, coordinated care intervention aims to improve medication adherence and hypertension outcomes among African-American, Latino and Vietnamese immigrant patients. The proposed practice-based RCT is designed to meet the following specific aims: Aim 1: Implement IMPaCT, an innovative, tailored adherence intervention delivered by a pharmacist and CHW team. Aim 2: Determine the short- and long-term effectiveness of IMPaCT by assessing pre- to post-intervention changes in: a) medication adherence (proximal outcome) and blood pressure (BP, distal outcome), and b) other comorbid health outcomes (e.g., HbA1c, BMI) using a randomized controlled trial. Aim 3: Identify factors associated with IMPaCT effectiveness including: a) tailored intervention features, b) medication beliefs, c) barriers to adherence, d) intervention dose, e) health literacy, and f) cultural group. We will follow an intention-to-treat randomized design using a waitlist control with 450 African-American, Latino, and Vietnamese patients with hypertension and low (<80%) medication adherence. Data collection via pill count, self-report, the electronic health record, and clinical measures will assess medication adherence, BP and other factors at baseline (pre-intervention) and at 4, 10, and 24 weeks post-intervention. IMPaCT is an innovative coordinated care team intervention to improve medication adherence and blood pressure derived from research findings that builds on existing clinical practice. Designed with an eye towards sustainability, IMPaCT incorporates billable pharmacist and CHW services for patients with low medication adherence and high burdens of chronic illness and preventable consequences. IMPaCT offers interprofessional team care with comprehensive expertise and complementary skill sets that mitigate the silo effect of specialized medicine to deliver primary care to diverse, high-risk populations experiencing disparities in hypertension.