Understanding variations in determinants of medicationadherence to inform a tailored intervention: the case ofstatin adherence

了解药物依从性决定因素的变化，以便为量身定制的干预措施提供信息：他汀类药物依从性的案例

• 批准号: 2741300
• 金额: --
• 依托单位: Imperial College London
• 依托单位国家: 英国
• 项目类别: Studentship
• 财政年份: 2022
• 资助国家: 英国
• 起止时间: 2022 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=studentship-2741300
• 关键词: Understanding; variations; determinants; medicationadherence; inform

Statins lower levels of 'bad' cholesterol, and stop or slowthe progression of cardiovascular disease (CVD). Statinadherence is associated with lower risk of CVD events (e.g.heart attack/stroke), and death from CVD or any cause(Martin-Ruiz 2018; Vrecer 2003). However, after two years,only around 25% of patients take statins as prescribed(Brown 2011).Despite this, there is a relative lack of research intopsychological determinants of statin adherence, orcategorisations of the behavioural components of effectivestatin interventions. The proposed PhD will use behaviouralscience approaches and qualitative and quantitativemethods to identify how determinants of non-adherencediffer between different patient groups and betweenindividuals. This will inform the design of a scalableadherence intervention, tailored to individual needs. Thisalternative to a one-size-fits-all approach can addressvarying barriers to taking medications.The project will be a collaboration between ImperialCollege London and Hammersmith and Fulham Partnership(a GP Partnership of 5 GP practices), building on existingresearch from this team.The first stage of the PhD will investigate determinants ofadherence across patient groups and individuals, using avariety of methods, all based on the Theoretical DomainsFramework: a comprehensive framework of behaviouralpredictors. Secondary analysis of our ongoing survey onpsychological determinants of statin adherence will testhow these differ in different groups, e.g. those on manymedications, those who have had a CVD event, ethnicminorities. An interview study will assess adherencedeterminants in adherent and non-adherent patients, andthe patterns seen across individuals. This will be complemented by a systematic review of statin adherencedeterminants, and a review of statin adherenceinterventions, with intervention components categorisedusing the Behaviour Change Techniques Taxonomy.The student will map all these findings to identifyadherence determinants across different groups, andcorresponding techniques to address each adherencebarrier.The second stage will design a tailored intervention toaddress the varying determinants, building on stage 1findings. The intervention will be co-designed usingworkshops with diverse patients, clinicians, behaviouralscientists and designers. The intervention will be scalable,and tailored to specific needs of each patient e.g. through apathway of intervention components, based on patientcharacteristics and reported barriers. A pilot and feasibilitystudy will assess whether recruitment is feasible, trialprocesses run smoothly, and the intervention is acceptable.The effect of the intervention on adherence will beexamined, along with differences between patient groups.An interview and survey will investigate patient andclinician views on the intervention, and potentialimprovements. The PhD findings will inform a subsequentfull trial of the intervention.

他汀类药物降低“坏”胆固醇水平，阻止或减缓心血管疾病（CVD）的进展。他汀类药物依从性与心血管疾病事件（如心脏病发作/中风）和心血管疾病或任何原因导致的死亡风险较低有关（Martin-Ruiz 2018; Vrecer 2003）。然而，两年后，只有大约25%的患者按照规定服用他汀类药物（Brown 2011）。尽管如此，关于他汀类药物依从性的心理决定因素或有效的他汀类药物干预的行为成分分类的研究相对缺乏。拟议的博士学位将使用行为科学方法和定性和定量方法来确定不同患者群体和个体之间不依从性的决定因素如何不同。这将为可扩展的领导力干预措施的设计提供信息，以满足个人需求。这种“一刀切”方法的替代方案可以解决服用药物的各种障碍。该项目将是伦敦帝国理工学院和哈默史密斯和富勒姆合作伙伴关系（一个由5个GP实践组成的GP合作伙伴关系）之间的合作，以该团队现有的研究为基础。博士学位的第一阶段将研究患者群体和个人的依从性决定因素，使用各种方法，所有这些方法都基于理论领域框架：一个全面的行为预测框架。对我们正在进行的关于他汀类药物依从性的心理决定因素的调查进行二次分析，将测试这些因素在不同人群中的差异，例如，服用多种药物的人群、有心血管疾病事件的人群、少数民族。访谈研究将评估依从性和非依从性患者的依从性决定因素，以及个体之间的模式。这将通过他汀类药物依从性决定因素的系统综述和他汀类药物依从性干预措施的综述来补充，并使用行为改变技术分类法对干预成分进行分类。学生将绘制所有这些发现，以确定不同群体的依从性决定因素，以及相应的技术来解决每个依从性障碍。第二阶段将在第一阶段发现的基础上，设计量身定制的干预措施，以解决不同的决定因素。干预措施将由不同的患者、临床医生、行为科学家和设计师共同设计。干预将是可扩展的，并根据每个患者的具体需求量身定制，例如，根据患者特征和报告的障碍，通过干预组成部分的途径。一项试点和可行性研究将评估招募是否可行，试验过程是否顺利进行，以及干预是否可以接受。将检查干预对依从性的影响，以及患者组之间的差异。访谈和调查将调查患者和临床医生对干预和潜在改进的看法。博士的研究结果将为后续的干预试验提供信息。