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

摘要 美国在高血压方面面临着严重的种族和民族差异，这一差异因 药物依从性。然而，很少有现有的药物依从性干预措施是针对特定的 不同人群的文化信仰，他们也面临着与以下方面有关的重大结构性障碍 贫穷、获得护理的机会和粮食不安全。建议提高药剂师的服药依从性 CHW团队(Impact)干预响应了要求遵守的呼吁，这些干预是为 少数族裔群体的具体需求。IMPACT是一项以实践为基础的随机对照试验 测试针对高危人群的针对个人和文化的综合干预措施的有效性 高血压、多药联用、依从性低的患者。Impact利用 临床药剂师和一名社区卫生工作者(CHW)将担任文化经纪人和 患者导航员，以解决个人、临床、社会文化和结构性障碍的坚持。这 全面、量身定制、协调的护理干预旨在提高服药依从性和 非裔美国人、拉丁裔和越南移民患者的高血压结局。建议数 以实践为基础的循证施策旨在实现以下具体目标： 目标1：实施药剂师提供的创新、量身定制的依从性干预措施Impact CHW团队。 目标2：通过评估干预前和干预后来确定影响的短期和长期有效性 变化：a)服药依从性(近端结局)和血压(血压，远端结局)，以及b) 使用随机对照试验的其他共病健康结果(例如，糖化血红蛋白、体重指数)。 目标3：确定与影响效果有关的因素，包括：a)量身定制的干预特征，b) 药物信仰，c)坚持的障碍，d)干预剂量，e)健康素养，f)文化群体。 我们将遵循意向治疗随机设计，使用等待名单对照，有450名非裔美国人， 拉美裔和越南高血压患者，服药依从性低(80%)。通过以下方式收集数据 药物计数、自我报告、电子健康记录和临床措施将评估服药依从性，BP 以及在基线(干预前)以及干预后4、10和24周的其他因素。影响是一种 创新的协调护理团队干预，提高服药依从性和派生血压 来自建立在现有临床实践基础上的研究结果。设计着眼于可持续发展， Impact为服药依从性低的患者提供付费药剂师和CHW服务，并 慢性疾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，可缓解专业医学的竖井效应 向高血压方面存在差异的各种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.