Multifaceted Prospective Memory Intervention to Improve Medication Adherence

描述（由申请人提供）：坚持服药是预防高血压及其随后的有害和昂贵影响（包括中风、心力衰竭和认知能力下降）的最重要的策略。依从性是高血压的一个重要问题，估计只有50%的人适当地坚持服用处方药。高血压也是一种无症状的慢性疾病，因此没有内部记忆提示药物服用。高血压在老年人中普遍存在，他们的认知过程出现下降，否则可能会弥补缺乏内部线索来支持坚持。本研究的目的是测试一种家庭、量身定制的、多方面的前瞻性记忆干预对65岁及以上成人抗高血压药物依从性的影响。干预是基于前瞻记忆领域最近的经验和理论发展，并着重于通过使用相对保存良好的线索驱动和自动过程来增强药物依从性。自我管理至少一种降压药的老年人，在4周的基线监测后，这种药物的依从性低于或等于90%，将被随机分配到两组中的一组。一组将接受由四个阶段组成的干预：建立关系，教育，实施多方面策略以提高前瞻性记忆，每周强化会议，为期三周。教育对照组将只接受干预第一阶段和第二阶段的一部分，建立关系和教育，并将接受与干预组类似的额外3周的访问，但不接受策略培训。依从性将通过药物电子监测来确定。假设干预组将有更大的总体依从性，并且总体依从性与执行功能/工作记忆之间的关系将小于教育对照组，因为干预减少了对高水平执行功能实现依从性的需求。坚持模式将在六个月的时间内进行评估。这项研究的一个主要公共卫生后果是限制老年人的残疾，因为高血压与认知能力下降和心脑血管疾病（包括中风）有关。虽然这种干预措施正在对老年人进行测试，但这种干预措施对改善其他人群的依从性具有广泛的意义。公共卫生相关性：遵医嘱服药是预防高血压最重要的方法。这项研究通过测试一种帮助人们按处方服药的干预措施，解决了高血压这一重要的公共卫生问题。如果我们能改善人们服用降压药的方式，我们就能改善老年人的生活质量，降低医疗成本。

DESCRIPTION (provided by applicant): Adherence to medication is the single most important strategy to prevent high blood pressure and its subsequent deleterious and costly effects including stroke, heart failure and cognitive decline. Adherence is a significant problem in hypertension with estimates of only 50 percent appropriately adhering to their prescribed medications. Hypertension is also an asymptomatic chronic illness and therefore one without internal memory cues to medication taking. Hypertension is prevalent among older adults who have been shown to experience declines in cognitive processes that otherwise might compensate for the lack of internal cues to support adherence. The purpose of the proposed study is to test the effect of an in-home, tailored, multifaceted prospective memory intervention on adherence to antihypertensive medication for adults 65 years of age and older. The intervention is grounded in recent empirical and theoretical developments in the area of prospective memory and focuses on enhancing medication adherence through the use of relatively well-preserved cue- driven and automatic processes. Older adults who are self-managing at least one antihypertensive agent and are adherent to this medication less than or equal to 90 percent following 4 weeks of baseline monitoring, will be randomly assigned to one of two groups. One group will receive the intervention consisting of 4 phases: establishing a relationship, education, implementation of multifaceted strategies to improve prospective remembering and weekly reinforcement sessions for 3 weeks. The education comparison group will only receive part of the first and second phase of the intervention, establishing a relationship and education and will be visited for an additional 3 weeks similar to the visits for the intervention group, but will not receive strategy training. Adherence will be determined using Medication Electronic Monitoring. It is hypothesized that the intervention group will have greater overall adherence and that the relationship between overall adherence and executive function/working memory will be smaller than for the education comparison group because the intervention reduces the need for high levels of executive function to achieve adherence. Patterns of adherence will be assessed across a six-month period. A major public health consequence of this study is limiting disabilities among older adults because hypertension is associated with cognitive decline and cardiovascular and cerebrovascular disease including stroke. While this intervention is being tested with older adults, the intervention has broad implications for improving adherence in other populations. PUBLIC HEALTH RELEVANCE: Taking medications as prescribed is the single most important way to prevent the effects of high blood pressure. This study addresses the important public health problem of high blood pressure by testing an intervention to help people take medications as prescribed. If we can improve the way people take blood pressure medicines, we can improve the quality of life for older adults and decrease health care costs.