Improving medication adherence among people with diabetes who are homeless

提高无家可归的糖尿病患者的药物依从性

• 批准号: 10543822
• 负责人: Katherine Diaz Vickery
• 金额: $ 16.24万
• 依托单位: HENNEPIN HEALTHCARE RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-03-28 至 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10543822
• 关键词: Abbreviations; Accident and Emergency department; Acute; Address; Adherence; Adult; Aftercare; Age; American; Appointment; Behavior Therapy; Behavioral; Behavioral trial; Cardiovascular Diseases; Caring; Cessation of life; Chronic; Chronic Disease; Clinic; Clinical; Collaborations; Communities; Complications of Diabetes Mellitus; Counseling; County; Data; Development; Development Plans; Diabetes Mellitus; Diet; Disparity population; Drug Prescriptions; Educational Materials; Environment; Ethnic Origin; Exercise; Focus Groups; Food Access; Foundations; Frequencies; Funding; Future; General Population; Glucose; Glycosylated hemoglobin A; Goals; Grant; Health; Health Care Costs; Health behavior; Healthcare; Healthcare Systems; Homelessness; Hospitalization; Hospitals; Insurance Coverage; Intervention; Interview; Kidney; Leadership; Learning; Link; Manuals; Manuscripts; Measures; Medical Research; Medical center; Memory; Mental disorders; Mentors; Mentorship; Metabolic; Methods; Minnesota; Modeling; Moods; Motivation; Neighborhood Health Center; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Participant; Patient Self-Report; Patient-Focused Outcomes; Patients; Perception; Persons; Pharmaceutical Preparations; Pharmacy facility; Population; Populations at Risk; Positioning Attribute; Prevalence; Printing; Procedures; Protocols documentation; Provider; Psychosocial Assessment and Care; Public Health; Publications; Randomized, Controlled Trials; Reduce health disparities; Refrigeration; Research; Research Personnel; Risk; Shelter facility; Social support; Statistical Methods; Substance Use Disorder; Telephone; Testing; Training; Training Support; Translational Research; Universities; Visit; Vulnerable Populations; Work; Writing; acceptability and feasibility; arm; behavior test; career; career development; clinical translation; collaborative care; comorbidity; cost; design; diabetes management; disparities in morbidity; disparity reduction; evidence base; experience; food insecurity; glycemic control; health care service utilization; health disparity; health record; housing instability; improved; innovation; insurance claims; medication compliance; meetings; member; modifiable behavior; mortality; motivational enhancement therapy; multidisciplinary; novel; peer; pilot test; pilot trial; practice-based research network; preference; premature; professor; psychosocial; public health relevance; racial minority; recruit; response; safety net; skills; standard care; supported housing; theories; therapy design; trend; vascular stress

PROJECT SUMMARY The long-term objective of this project is to reduce the diabetes health disparities of people with type 2 Diabetes who experience Homelessness, herein abbreviated as DH. The study will focus on diabetes medication adherence as a modifiable behavior known to correlate with glycemic control, all-cause mortality, all-cause hospitalization, and health care cost. The aims are to: (1) Develop the initial Diabetes Homeless Medication Support (D-Homes) treatment manual through focus groups with DH (N=30) at various levels of glycemic control (HgA1c<7, 7-9, >9) and interviews with their multi-disciplinary providers (N=12), (2) Test patient perceptions of the feasibility and acceptability of study procedures and refine the D-Homes treatment manual through test cases (n=10), and (3) Conduct a pilot randomized control trial (N=54) to compare the effect of D-Homes (weekly phone/in-person sessions over 12 weeks) vs. enhanced standard care (identify/reinforce care team, printed educational materials) on medication adherence, glycemic control, and health care utilization. These aims follow a sequential exploratory mixed methods approach. Qualitative focus groups and interviews will gather data about the values, preferences, and barriers to medication adherence faced by DH and their response to proposed intervention components. The initial protocol will be developed using existing evidence-based models and interventions to improve medication adherence, specifically the Information Motivation Behavioral Skills and Collaborative Care Models and use of motivational interviewing as a counseling style. It will also include explicit support for housing, food access, and other psychosocial needs. We will further tailor our protocol by conducting ten test cases. A final protocol will be developed by integrating qualitative and quantitative findings from Aims 1 and 2 with input from a multi-stakeholder panel with providers and community members with lived experience of these issues and the mentorship team. This project will prepare Dr. Vickery for a career as an independent investigator focused on overcoming diabetes and other health disparities among historically disadvantaged groups. Her career development plan includes training goals to: (i) develop tailored, theory-based behavioral interventions to address the needs of vulnerable groups using mixed methods data, (ii) learn to conduct rigorous behavioral trials and statistical methods for analyzing results, (iii) learn to develop and use measures of patient-centered outcomes and medication adherence, (iv) advanced manuscript and grant-writing skills. The research will be conducted in an ideal environment, Hennepin County Medical Center, the largest safety net health care system in the region, and its research arm, the Minneapolis Medical Research Foundation. It will be further strengthened by Dr. Vickery’s appointment as an Assistant Professor at University of Minnesota, a large academic health center with a Clinical Translational Sciences Institute. The interviews and trial will be conducted at shelters in close collaboration with Hennepin County Health Care for the Homeless clinics where Dr. Vickery works clinically.

项目概要 该项目的长期目标是减少 2 型糖尿病患者的健康差异 无家可归的糖尿病患者，本文缩写为 DH。该研究将重点关注糖尿病 药物依从性是一种可改变的行为，已知与血糖控制、全因死亡率、 全因住院和医疗保健费用。目标是： (1) 培养最初的糖尿病无家可归者 通过不同级别的 DH (N=30) 焦点小组进行药物支持 (D-Homes) 治疗手册 血糖控制（HgA1c<7、7-9、>9）和与其多学科提供者的访谈（N=12），（2）测试 患者对研究程序的可行性和可接受性的看法并完善 D-Homes 治疗 手动通过测试用例（n = 10），以及（3）进行试点随机对照试验（N = 54）以比较 D-Homes（12 周内每周电话/面对面会议）与强化标准护理的效果 （确定/加强护理团队、印刷教育材料）关于药物依从性、血糖控制和 医疗保健利用。这些目标遵循顺序探索性混合方法。定性聚焦 小组和访谈将收集有关价值观、偏好和药物依从性障碍的数据 卫生署面临的问题及其对拟议干预措施的回应。将制定初始协议 使用现有的循证模型和干预措施来提高药物依从性，特别是 信息动机行为技能和协作护理模型以及使用动机访谈作为 一种咨询方式。它还将包括对住房、食物获取和其他社会心理需求的明确支持。 我们将通过进行十个测试用例来进一步定制我们的协议。最终协议将通过整合来制定 目标 1 和 2 的定性和定量调查结果以及多利益相关者小组与提供商的意见 以及对这些问题有实际经验的社区成员以及指导团队。该项目将 为维克里博士作为一名独立研究者的职业生涯做好准备，专注于克服糖尿病和其他疾病 历史上弱势群体之间的健康差距。她的职业发展计划包括培训 目标是： (i) 制定有针对性的、基于理论的行为干预措施，以满足弱势群体的需求 使用混合方法数据，（ii）学习进行严格的行为试验和统计方法进行分析 结果，(iii) 学习制定和使用以患者为中心的结果和药物依从性的衡量标准，(iv) 先进的手稿和资助写作技巧。研究将在理想的环境中进行， 亨内平县医疗中心是该地区最大的安全网医疗保健系统及其研究机构， 明尼阿波利斯医学研究基金会。 Vickery 博士被任命为 明尼苏达大学助理教授，该大学是一家大型学术健康中心，拥有临床转化中心 科学研究所。访谈和审判将与亨内平密切合作在避难所进行 县卫生保健无家可归者诊所是维克里医生临床工作的地方。