Cohort Study of Medication Adherence Among Older Adults

老年人服药依从性队列研究

• 批准号: 7489297
• 负责人: Marie Krousel-Wood
• 金额: $ 47.47万
• 依托单位: OCHSNER CLINIC FOUNDATION
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-09-01 至 2011-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7489297
• 关键词: Address; Adherence; Adult; African American; Age; Age-Years; American; Antihypertensive Agents; Behavior Therapy; Behavioral; Cardiovascular Diseases; Cardiovascular system; Class; Clinical; Clinical Treatment; Cohort Studies; Communication; Comorbidity; Computerized Medical Records Systems; Coronary heart disease; Data; Data Collection; Diagnosis; Disease Outcome; Economics; Elderly; End stage renal failure; Enrollment; Essential Hypertension; Female; Future; Gender; Health; Health Services Accessibility; Healthcare Systems; Hispanics; Hypertension; Hypotension; Incidence; Intervention; Knowledge; Lead; Life Style; Lifestyle Therapy; Managed Care; Manuscripts; Measures; Medical Records; Medicare; Modeling; Modification; Outcome; Participant; Patients; Perception; Pharmaceutical Preparations; Pharmacy facility; Primary Health Care; Provider; Psychosocial Factor; Quality Control; Quality of life; Race; Rate; Recruitment Activity; Relative Risks; Reporting; Risk; Risk Factors; Sampling; Severities; Sex Functioning; Stroke; Structure; Surveys; System; Telephone; Therapeutic; Treatment Factor; blood pressure regulation; computerized; copayment; design; eligible participant; follow-up; health care service utilization; improved; male; medication compliance; modifiable risk; mortality; prospective; psychosocial; quality assurance; racial difference; satisfaction; social

DESCRIPTION (provided by applicant): At least 50 million adult Americans have hypertension, an important modifiable risk factor for coronary heart disease, stroke and end-stage renal disease. Efficacious blood pressure lowering medications are available but low adherence to medication by older adults can lead to poor outcomes.The overall objective of the proposed prospective cohort study is to determine factors that are associated with reduced antihypertensive medication adherence among older adults (>=65 years). The factors to be investigated include psychosocial, behavioral, quality of life (QOL), health care system issues including copayment/benefit, knowledge, sexual function (SF), medication class, use of unconventional therapies/lifestyle modifications.and clinical factors. The impact of these factors will be assessed overall and by gender and race. We propose to conduct a prospective cohort study with 2,000 participants >= 65 years of age with diagnosed essential hypertension (HTN) in a managed care organization (MCO). This study is designed to have 80% statistical power to detect relative risks of less than 1.5 of medication adherence at baseline and less than 2.0 for transitioning from high to medium or medium to low adherence over 2 years of follow-up associated with demographic, behavioral, clinical and treatment factors. A random, race-and gender- stratified sample of HTN patients >=65 years enrolled in the Medicare Risk Product of a large southern MCO will be selected from all eligible participants. Patients will be followed prospectively for an average of 2 years and medication adherence, QOL , SF, demographic, treatment, socio-economic, knowledge, clinical and behavioral factors will be determined at baseline and during annual telephone-administered follow-up surveys. Chart abstraction at baseline and follow-up will be used to assess blood pressure control, cardiovascular outcomes and HTN severity. MCO computerized medical record system will be used toaccess data on HTN medications, cardiovascular outcomes, copayment/benefit and utilization. The primary outcome will be medication adherence at baseline and changes in medication adherence during follow-up. In addition, the impact of medication adherence at baseline on blood pressure control, QOL, utilization, and cardiovascular outcomes during follow-up will be examined. Results of this study will lay the groundwork for interventions to improve medication adherence and clinical outcomes in older adults with hypertension and will increase our understanding of factors contributing to therapeutic outcomes in the use of medications by these patients.

描述（由申请人提供）：至少有 5000 万美国成年人患有高血压，这是冠心病、中风和终末期肾病的重要可改变危险因素。有效的降血压药物是可用的，但老年人对药物依从性低可能导致不良结果。拟议的前瞻性队列研究的总体目标是确定与老年人（> = 65 岁）抗高血压药物依从性降低相关的因素。要调查的因素包括社会心理、行为、生活质量（QOL）、医疗保健系统问题（包括共付/福利）、知识、性功能（SF）、药物类别、非常规疗法的使用/生活方式改变以及临床因素。这些因素的影响将按性别和种族进行总体评估。我们建议在管理医疗组织 (MCO) 中对 2,000 名年龄 >= 65 岁、诊断为原发性高血压 (HTN) 的参与者进行前瞻性队列研究。这项研究的设计具有 80% 的统计功效，可检测基线时药物依从性低于 1.5 的相对风险，以及在 2 年随访中与人口、行为、临床和治疗因素相关的从高依从性转变为中依从性或中依从性转变为低依从性的相对风险低于 2.0。将从所有符合条件的参与者中随机抽取参加南部大型 MCO 医疗保险风险产品的 65 岁以上 HTN 患者的种族和性别分层随机样本。患者将被前瞻性随访平均 2 年，药物依从性、生活质量、SF、人口统计学、治疗、社会经济、知识、临床和行为因素将在基线和年度电话随访调查中确定。基线和随访时的图表提取将用于评估血压控制、心血管结局和高血压严重程度。 MCO 计算机化医疗记录系统将用于访问有关 HTN 药物、心血管结果、共付额/福利和利用率的数据。主要结果是基线的药物依从性和随访期间药物依从性的变化。此外，还将检查基线药物依从性对随访期间血压控制、生活质量、利用率和心血管结局的影响。这项研究的结果将为改善老年高血压患者的药物依从性和临床结果的干预措施奠定基础，并将增加我们对影响这些患者使用药物治疗结果的因素的理解。