Antidepressant Adherence via Telephonic Interactive Voice Recognition (IVR)
通过电话交互式语音识别 (IVR) 实现抗抑郁药物依从性
基本信息
- 批准号:8054270
- 负责人:
- 金额:$ 57.46万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2010
- 资助国家:美国
- 起止时间:2010-04-01 至 2013-03-31
- 项目状态:已结题
- 来源:
- 关键词:21 year oldAIDS/HIV problemAdherenceAdoptionAdultAffectAntidepressant adherenceAntidepressive AgentsAnxietyAnxiety DisordersAreaCharacteristicsChronic DiseaseClientComplexComputerized Medical RecordDataDevelopmentDiagnosisDiseaseDisease ManagementDistalEducationEffectivenessEnrollmentFocus GroupsFutureGrantGroup InterviewsHealth Care CostsHealth Maintenance OrganizationsHealth ServicesHealth StatusHealthcareIncentivesInformation TechnologyInternetInterventionInterviewLifeMailsMaintenanceMeasuresMental DepressionMental disordersMethodsNIH Program AnnouncementsNational Institute of Mental HealthOutcomeParticipantPatient EducationPatient Self-ReportPatientsPersonsPharmaceutical PreparationsPharmacistsPharmacy facilityPopulationProviderQuality-Adjusted Life YearsRandomizedRandomized Clinical TrialsRandomized Controlled TrialsReportingResearch PersonnelResearch Project GrantsRuralServicesSiteSolutionsSymptomsSystemTechnologyTelephoneTestingTimeUncertaintyUnipolar DepressionUnited States Agency for Healthcare Research and QualityVisitabstractingarmbasechronic care modelclinically relevantcommon treatmentcompliance behaviorcostcost effectivenessdissemination trialeconomic evaluationexperiencefollow-uphealth care service utilizationhealth information technologyimplementation trialimprovedinformantinnovationmedication compliancememberpractice-based research networkprimary outcomeprogramspublic health relevanceresponsesafety netsatisfactionsecondary outcomeservice interventionspeech recognitionsuccesstreatment adherencetreatment as usualtrial comparingvoice recognitionwillingness to pay
项目摘要
DESCRIPTION (provided by applicant): Antidepressants (ADs) are the most frequently prescribed class of psychotropic medications and the most common treatment for depression and anxiety disorders-yet patient adherence is poor and is widely viewed as contributing to reduced effectiveness. Fortunately, AD adherence can be improved via interventions consistent with the Chronic Care Model (CCM). However, traditionally- delivered adherence promotion programs are complex, staff-intensive, and costly-barriers to wider adoption, implementation, and maintenance of these programs in real-world settings. Our aim is to carry out a trial of a low-cost, IT-enabled AD adherence program, specifically a direct-to-patient, automated telephone interactive voice recognition (IVR) intervention to boost patient AD persistence. This intervention is consistent with the CCM but is much more amenable to widespread dissemination over a large population. In an initial startup period we will adapt and pilot existing IVR adherence calls and scripts, informed by formative focus groups and interviews with key informants (patients, providers). Following this, we will conduct a pragmatic, randomized clinical trial enrolling 3,100 HMO members ages 21 to 75, recently started on an incident course of AD medications for associated unipolar depression and/or anxiety diagnoses. Participants will be randomized 1:1 to either a treatment as usual (TAU) control condition or to TAU plus the IVR automated telephone program. Recruitment will continue for 18 months, with periodic participant-level follow-up for 40 weeks. The IVR program will deliver reminder and/or tardy calls timed to projected AD refill dates. The intervention also optionally offers brief psycho-education, or transfer to a live pharmacist or the HMO mail refill pharmacy. The primary outcome will be the Estimated Level of Persistence with Therapy (ELPT) for ADs, based on prescription refill data abstracted from the HMO's electronic medical record (EMR). We hypothesize that participants in the IVR study arm will have a significantly higher rate of AD persistence than those in the TAU control condition. Secondary medication adherence outcomes include continuous measure of medication acquisition (CMA) and continuous measure of medication gaps (CMG). Other secondary outcomes include self-report depression and anxiety symptoms, general health status, patient and provider satisfaction, and healthcare costs and usage. We will also conduct cost-effectiveness analyses (CEA) to assess the value-for-money (cost per depression free day gained, and cost per quality adjusted life year gained) of the IVR technology compared to TAU. Costs will include IVR development and implementation as well as EMR-derived healthcare utilization data (visits, medications, etc.), augmented with participant report of out-of-plan services. Finally, evaluative qualitative interviews will be conducted with key stakeholders to identify barriers/facilitators of intervention implementation-keys for future dissemination.
PUBLIC HEALTH RELEVANCE: Persons taking antidepressant medication often stop too early to get full benefit. Programs exist to help these patients stay on medication longer, but most are too complicated and costly to be widely used. This study will test an automated telephone calling program to help patients obtain refills at the right time and stay on antidepressants longer. This program is low cost and can be delivered to widespread populations much more easily than other approaches.
描述(申请人提供):抗抑郁药(ADS)是最常见的精神药物处方类别,也是治疗抑郁症和焦虑症的最常见疗法-然而患者依从性差,被广泛认为是导致疗效降低的原因之一。幸运的是,通过符合慢性护理模式(CCM)的干预措施,AD的依从性可以得到改善。然而,传统上提供的遵从性促进计划复杂、人员密集且成本高昂,这些障碍阻碍了这些计划在实际环境中的广泛采用、实施和维护。我们的目标是进行一项低成本、IT支持的AD坚持计划的试验,特别是直接对患者进行自动电话交互语音识别(IVR)干预,以提高患者的AD持久性。这种干预与CCM是一致的,但更容易在大量人口中广泛传播。在最初的启动阶段,我们将调整和试行现有的IVR遵守要求和脚本,通过形成焦点小组和与关键信息者(患者、提供者)的访谈来了解情况。在此之后,我们将进行一项务实的随机临床试验,招募3100名年龄在21岁至75岁之间的HMO成员,他们最近开始接受AD药物的事件疗程,以治疗相关的单相抑郁和/或焦虑诊断。参与者将被随机分为两组,一组是常规治疗(TAU)对照组,另一组是TAU加IVR自动电话项目。征聘将持续18个月,参与者一级的定期后续行动将持续40周。IVR计划将按预计的AD充值日期发送提醒和/或延迟呼叫。干预还可以提供简短的心理教育,或者转移到现场药剂师或HMO邮件再灌装药房。主要结果将是基于从HMO的电子医疗记录(EMR)中提取的处方再填充数据,估计ADS的持续治疗水平(ELPT)。我们假设,IVR研究组的参与者将比TAU对照组的参与者具有显著更高的AD持久率。二次用药依从性结果包括连续用药测量(CMA)和连续用药缺口测量(CMG)。其他次要结果包括自我报告的抑郁和焦虑症状、总体健康状况、患者和提供者的满意度,以及医疗费用和使用情况。我们还将进行成本效益分析(CEA),以评估IVR技术与TAU相比的性价比(获得的每一无抑郁日的成本,以及获得的每一质量调整寿命年的成本)。费用将包括IVR的开发和实施以及EMR衍生的医疗保健利用数据(就诊、药物等),以及计划外服务的参与者报告。最后,将与主要利益攸关方进行评价性定性访谈,以确定实施干预措施的障碍/促进者--今后传播的关键。
公共卫生相关性:服用抗抑郁药物的人往往过早停止服用,无法充分受益。现有的计划可以帮助这些患者更长时间地接受药物治疗,但大多数计划过于复杂和昂贵,无法广泛使用。这项研究将测试一种自动电话呼叫程序,以帮助患者在正确的时间获得补充,并更长时间地服用抗抑郁药物。这项计划成本低,而且比其他方法更容易提供给广泛的人群。
项目成果
期刊论文数量(0)
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GREGORY N CLARKE其他文献
GREGORY N CLARKE的其他文献
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{{ truncateString('GREGORY N CLARKE', 18)}}的其他基金
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10192431 - 财政年份:2021
- 资助金额:
$ 57.46万 - 项目类别:
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- 批准号:
10624317 - 财政年份:2021
- 资助金额:
$ 57.46万 - 项目类别:
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8921270 - 财政年份:2014
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