Clinic-based Intervention to Improve Medication Adherence to Reduce CVD Risks

描述（由申请人提供）：心血管疾病（CVD）是美国死亡和残疾的主要原因。来自随机试验的证据表明，当以标准剂量使用高血压和血脂紊乱药物时，它们具有显著的降低风险作用。然而，对血脂管理和降压药物的依从性问题是众所周知的。2002年，国家心肺和血液研究所的成人高胆固醇检测、评估和治疗专家小组（ATP III）报告说，依从性差跨越种族和年龄组、社会经济阶层、急性和慢性疾病以及治疗方案。在所有类型的临床环境中均观察到不依从或部分依从的后果。ATP III还报告说，没有一个原因导致药物依从性差。由于没有单一的原因，不可能有一种方法来提高所有人的依从性。该第二阶段应用的目标是继续开发并对这种实用且易于交付的干预系统进行功效测试，以帮助患有血脂障碍和高血压的患者利用多种策略来提高药物依从性。干预将在常规诊所访视期间利用基于计算机的软件程序来：（1）评估患者独特的药物依从性挑战;（2）为他或她提供关于依从他或她的医生处方的药物的定制信息;以及（3）基于患者的药物依从性评估为该患者的医生提供建议。还有其他几种方法可用于改善药物依从性。然而，这个拟议的系统提供了独特的功能。它利用非常低成本的技术来指导患者遵循适合其独特需求的增强策略。患者评估发生在看医生之前，因此可以提高医生处理药物相关讨论的效率。该系统应提高医生解决关键依从性问题的一致性。此外，医生对患者的影响可能会被利用。由于这种干预方法依赖于医生对患者当前生理特征的了解、最近的处方药物以及患者在该次访视时可能经历的副作用的了解，因此该系统应具有优于某些竞争系统的质量优势。在第二阶段，我们将根据第一阶段的结果加强该系统，并进行一项前瞻性疗效试验，以测试该系统改善药物依从性的能力，使用154名患者的干预组和154名在内科、心脏病学和社区卫生中心临床环境及其医生（N=16）接受治疗的患者的常规护理。公共卫生相关性：心脏病是美国死亡和残疾的主要原因，大多数人在服用处方药时都有问题。如果拟议的系统被证明能有效帮助人们服用降压和降胆固醇药物，它可以降低医疗成本，提高心脏病风险人群的生活质量。

DESCRIPTION (provided by applicant): Cardiovascular disease (CVD) is the leading cause of death and disability in the U.S. Evidence from randomized trials suggests that when medications for hypertension and lipid disorders are used at standard dosages, they have a significant risk-reduction effect. Yet, adherence problems to lipid management and antihypertensive medications are well known. In 2002, the National Heart Lung and Blood Institute's Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III) reported that poor adherence crosses ethnic and age groups, socioeconomic strata, acute and chronic diseases, and treatment regimens. The consequences of absent or partial adherence are observed in all types of clinical settings. The ATP III also reports that there is no one cause of poor medication adherence. Since there is no single cause, there is not likely to be one approach to improve adherence in all persons. The goal of this Phase II application is to continue development and conduct efficacy testing of this practical and easily delivered intervention system to assist patients with lipid disorders and hypertension to take advantage of several strategies for improving adherence to medications. The intervention will utilize a computer-based software program during routine clinic visits to: (1) assess a patient's unique medication adherence challenges; (2) provide him or her with tailored information on adhering to medications prescribed by his or her physician; and (3) provide suggestions for that patient's physician based on the patient's medication adherence assessment. Several other approaches are available to improve medication adherence. Yet, this proposed system offers unique features. It utilizes very-low-cost technology to direct a patient to adherence enhancing strategies that fit his or her unique needs. The patient assessment occurs just prior to seeing the physician so physician efficiency in dealing with medication-related discussions can be improved. The system should increase the consistency with which physicians address key adherence issues. Additionally, the physician's influence with the patient is potentially leveraged. Because this intervention approach relies on the physician's understanding of patients' current physiologic characteristics, most recent prescribed medications, and knowledge of side effects a patient may be experiencing at that visit, this system should have a quality advantage over some competing systems. In Phase II, we will enhance the system based on Phase I results, and conduct a prospective efficacy trial to test the ability of the system to improve medication adherence using an intervention groups with 154 patients and a usual care of 154 patients being treated in internal medicine, cardiology and community health center clinical settings and their physicians (N=16). Public Health Relevance: Heart disease is the leading cause of death and disability in the U.S. Most people have problems taking their prescribed medications. If the proposed system proves to be effective in helping people take blood pressure and cholesterol-lowering medicines, it can reduce the costs of healthcare and improve the quality of life for people who have a risk for heart disease.