A routinization intervention to improve adherence to complex medication regimens

提高复杂用药依从性的常规化干预 今天的许多成年人每天都会服用几种治疗慢性病的药物，其中许多都带有 不同的给药频率和指南(例如用餐时或用餐前)。服药依从性仍然是一个 尽管进行了数十年的研究，但仍是一个重大的世界性问题。改善个人干预的内部干预 药物依从性与信息或行为策略，重点关注潜在的信念和态度 意图、动机和能力对依从性的影响好坏参半，对临床的影响很小。 结果。一些新的证据表明，日常生活的规律性可能与坚持有关 而利用自动过程或习惯，可以促进坚持药物治疗方案。 通过利用和加强日常生活的规律性来关注外部或背景问题 活动和用药与习惯性行为(常规化)的联系，而不是费力的认知 加工可能是提高依从性的有效方法。卫生保健资源有限，因此 重要的是设计一种可行且经济有效的干预措施，以提高服药依从性， 转化为临床实践，融入患者生活。由于大多数医院的临床工作人员有限 在实践中，这也将是有用的，方便和快速地确定哪些患者的风险最高的不遵守。 因此，我们建议在成年糖尿病患者中进行一项随机对照试验。 正在接受复杂药物治疗的高血压和/或高脂血症患者。这项研究的目的是 1)测试常规化干预对服药依从性和健康结果的直接影响 以及2)评估相关特质、个性和认知功能因素如何影响 慢性疾病复杂用药方案对成人样本的治疗效果。从长远来看 这项研究的目标是开发一种简单、成本效益高的干预措施，以提高服药依从性 和健康结果(疾病控制、情绪、生活质量的生物标记物)，并很容易转化为临床 练习一下。第二个目标是确定从该计划中获益最多的患者的特征 干预措施和简短的筛查措施，以确定谁是最高风险的不遵守。

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.