Improving medication adherence among people with diabetes who are homeless

项目总结 该项目的长期目标是减少2型糖尿病患者的健康差距。 经历无家可归的糖尿病，在这里缩写为DH。这项研究的重点将是糖尿病 服药依从性是一种可改变的行为，已知与血糖控制、全因死亡率、 全因住院和医疗费用。其目的是：(1)发展最初的糖尿病无家可归者 通过重点小组与卫生署(N=30)在不同级别的药物支持(D-Home)治疗手册 血糖控制(HgA1c&lt；7，7-9，&gt；9)和他们的多学科提供者的访谈(N=12)，(2)测试 患者对研究程序和改进D-Home治疗的可行性和可接受性的感知 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-Home(12周内每周电话/面对面会议)与增强型标准护理的效果 (确定/加强护理团队，印刷教育材料)关于服药依从性、血糖控制和 卫生保健利用情况。这些目标遵循顺序探索性混合方法方法。定性焦点 小组和访谈将收集有关坚持用药的价值观、偏好和障碍的数据 卫生署面对的问题，以及他们对建议的干预措施的回应。将制定最初的议定书 使用现有的循证模型和干预措施来改善服药依从性，特别是 信息动机、行为技能和合作关怀模式以及动机访谈的使用 一种咨询风格。它还将包括对住房、食物获取和其他心理社会需求的明确支持。 我们将通过执行10个测试用例来进一步调整我们的协议。最终的协议将通过整合 来自目标1和目标2的定性和定量结果，以及多方利益相关者小组与供应商的意见 以及对这些问题有过生活经验的社区成员和导师团队。这个项目将 为维克里博士的职业生涯做好准备，成为一名专注于克服糖尿病和其他疾病的独立研究员 历史上处于不利地位的群体之间的健康差距。她的职业发展计划包括培训 目标：(1)制定量身定制、以理论为基础的行为干预措施，以满足弱势群体的需要 使用混合方法数据，(2)学习进行严格的行为试验和统计方法进行分析 结果，(3)学会制定和使用以患者为中心的结果和服药依从性的衡量标准，(4) 高级手稿和赠款撰写技巧。研究将在理想的环境中进行， 亨内平县医疗中心，该地区最大的安全网医疗保健系统，及其研究部门， 明尼阿波利斯医学研究基金会。维克里博士被任命为 明尼苏达大学助理教授，一家拥有临床翻译的大型学术健康中心 科学研究所。采访和审判将在收容所与亨内平密切合作进行 维克里医生在那里工作的无家可归者诊所的县卫生保健。

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.