A routinization intervention to improve adherence to complex medication regimens

常规化干预，以提高对复杂药物治疗方案的依从性

• 批准号: 8137202
• 负责人: CAROL S STILLEY
• 金额: $ 14.38万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/8137202
• 关键词: Adherence; Adult; Affect; Attitude; Behavior; Behavior Therapy; Behavioral; Belief; Biological Markers; Blood Pressure; Characteristics; Chronic Disease; Clinical; Cognitive; Complex; Control Groups; Diabetes Mellitus; Dose; Elderly; Electronics; Enrollment; Event; Frequencies; Future; Goals; Guidelines; Habits; Health; Healthcare; Hyperlipidemia; Hypertension; Intervention; Life; Link; Maintenance; Measures; Monitor; Moods; Motivation; National Research Council; Outcome; Patients; Personality Traits; Pharmaceutical Preparations; Phase; Population; Process; Quality of life; Randomized; Randomized Controlled Trials; Regimen; Research; Resistance; Resources; Risk; Sampling; Screening procedure; Short-Term Memory; Testing; Time; Translating; brief screening; clinical practice; cognitive function; cost; design; diabetic; disorder control; effective intervention; executive function; forgetting; group intervention; high risk; improved; intervention effect; medication compliance; middle age; remediation; trait; treatment effect

A routinization intervention to improve adherence to complex medication regimens Much of the today's adult population takes several medications for chronic illnesses daily, many of them with different dosing frequencies and guidelines (e..g. with or before meals). Medication adherence remains a significant world-wide problem despite decades of research. Intrapersonal interventions to improve medication adherence with informational or behavioral strategies, focused on beliefs and attitudes underlying intent, motivation, and ability, have demonstrated mixed effects on adherence and little impact on clinical outcomes. There is some emerging evidence that regularity of daily routine may be related to adherence and that capitalizing on automatic processes, or habits, can facilitate adherence to medication regimens. Focusing on external or contextual issues by capitalizing upon and strengthening regularity of every-day activities and linking medication taking to habitual behavior (routinization) rather than effortful cognitive processing may be an effective way to improve adherence. Health care resources are limited, therefore it is important to design a feasible and cost-effective intervention to improve medication adherence that will easily translate to clinical practice and be integrated into patients' lives. Because of limited clinical staff in most practices, it would also be useful to easily and quickly determine which patients are at highest risk of nonadherence. Thus, we propose to conduct a randomized controlled trial in a sample of diabetic adults with hypertension and/or hyperlipidemia who are on complex medication regimens. The aims of the study are to 1) test direct effects of a routinization intervention on medication adherence and health outcomes among poor adherers and 2) assess how relevant trait personality and cogntive function factors impact on the treatment effect in a sample of adults on complex medication regimens for chronic illnesses. The long term goal of this research is to develop a simple, cost-effective intervention that improves medication adherence and health outcomes (biomarkers of disease control, mood, quality of life) and easily translates to clinical practice. The secondary goal is to identify trait characteristics of patients who benefit most from the interventions with brief screening measure to identify patients who are at highest risk of non-adherence.

提高复杂药物治疗方案依从性的常规化干预 今天的大多数成年人每天都要服用几种治疗慢性病的药物，其中许多药物 不同的给药频率和指南（例如，G.或在用餐前）。药物依从性仍然是一个 这是一个全球性的问题，尽管经过了几十年的研究。自我干预以改善 药物依从性与信息或行为策略，重点是信念和态度的基础 意图、动机和能力，对依从性的影响好坏参半，对临床疗效的影响很小。 结果。有一些新的证据表明，规律的日常生活可能与坚持有关 利用自动化过程或习惯，可以促进对药物治疗方案的坚持。 通过利用和加强每天的规律性来关注外部或背景问题 活动，并将服药与习惯性行为（成瘾）联系起来，而不是努力的认知 处理可能是提高粘附性的有效方式。医疗资源有限，因此 重要的是要设计一个可行的和具有成本效益的干预措施，以提高药物依从性， 转化为临床实践，融入患者生活。由于大多数国家的临床工作人员有限， 在实践中，容易且快速地确定哪些患者处于不依从的最高风险也将是有用的。 因此，我们建议在糖尿病成人样本中进行一项随机对照试验， 高血压和/或高脂血症患者。该研究的目的是 1)测试干预措施对药物依从性和健康结果的直接影响， 2）评估相关的特质人格和认知功能因素如何影响 在成人样本中对慢性病的复杂药物治疗方案的治疗效果。长期 本研究的目的是开发一种简单、经济有效的干预措施，以提高药物治疗的依从性 和健康结果（疾病控制，情绪，生活质量的生物标志物），并容易转化为临床 实践第二个目标是确定从治疗中获益最多的患者的特质特征。 通过简短的筛查措施进行干预，以识别不依从风险最高的患者。