AN EXPERT SYSTEM TO IMPROVE MEDICATION ADHERENCE

尽管高血压的药物治疗取得了进展，但高达75%的高血压患者血压控制不佳。不受控制的高血压与发病率和死亡率增加有关，主要归因于未能坚持服用降压药物。不遵守药物治疗方案是一个长期存在的现象，增加了医疗保健的利用和成本。现有的研究表明，需要一个理论框架来提高我们设计有效干预措施的能力。跨理论模型（Transtheoretical Model， TTM）在药物依从性研究中的初步研究表明，该模型在该领域具有较强的解释力，具有指导干预措施发展的潜力。该快速通道提案的第一阶段涉及基于TTM的阶段匹配、个性化、交互式干预的开发和可行性测试。可行性包括主动招募70%的符合条件的参与者（n=300）参加依从性专家系统干预的随机试验，并评估干预材料的可接受性。计算机化的专家系统干预措施和与阶段相匹配的手册主动提供给整个人群，可以对依从性产生前所未有的影响，以更低的成本提供更高的可用性。将TTM应用于干预措施开发将提供该领域专家指出的必要的理论和个性化框架。拟议的商业应用：在5000万美国高血压患者中，高达75%（3750万）的人未能坚持他们的药物治疗方案。不坚持服用抗高血压药物增加了门诊、住院和急诊服务的使用率，这在药物相关发病率和死亡率中占很大比例，每年的费用超过760亿美元。有效且具有成本效益的基于人群的依从性专家系统可以降低发病率、死亡率、卫生保健利用率和相关成本，从而产生巨大的商业潜力。

Despite advances in pharrnacotherapy for hypertension, as many as 75% of hypertensive patients' blood pressure is poorly controlled. Uncontrolled hypertension is associated with increased morbidity and mortality and is largely attributed to failure to adhere with antihypertensive medications. Nonadherence to medication regimens is a long-standing phenomenon that increases health care utilization and costs. Existing research demonstrates that a theoretical framework is needed to advance our ability to design effective interventions. Preliminary research on the application of the Transtheoretical Model (TTM) to medication adherence suggests that the model has strong explanatory power in this area and has the potential to guide intervention development. Phase l of this Fast-Track proposal involves the development and feasibility test of a stage-matched, individualized, interactive intervention based on the TTM. Feasibility includes proactively recruiting 70% of eligible participants (n=300) to participate in a randomized trial of an adherence expert system intervention and evaluating acceptability of the intervention materials. Computerized expert system interventions and stage-matched manuals delivered proactively to entire populations can have unprecedented impacts on adherence, offering far greater availability at a low cost. Applying the TTM to intervention development will provide the theoretical and individualized framework that experts in the area have indicated is necessary. PROPOSED COMMERCIAL APPLICATIONS: Up to 75% (37.5 million) of the 50 million Americans afflicted with hypertension fail to adhere to their medication regimen. Nonadherence with antihypertensives, which increases utilization of outpatient, inpatient, and emergency services, contributes a large proportion of drug-related morbidity and mortality the annual costs of which exceed $76 billion. Effective and cost-effective population-based adherence expert systems can reduce morbidity, mortality, health care utilization, and related costs, resulting in tremendous commercial potential.