Improving the self-report of medication adherence problems in HIV

改善艾滋病毒药物依从性问题的自我报告

• 批准号: 8288882
• 负责人: IRA B WILSON
• 金额: $ 36.08万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-30 至 2014-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8288882
• 关键词: Adherence; Anti-Retroviral Agents; Cardiovascular Diseases; Caring; Chinese People; Chronic; Clinical Research; Cognitive; Comorbidity; Comprehension; Data; Development; Diabetes Mellitus; Diagnosis; Disease; Dose; Electronic drug monitoring; Event; Frequencies; Goals; Grant; HIV; Health; Individual; Intervention; Judgment; Language; Link; Measures; Mental Depression; Methods; Mission; Monitor; Outcome; Patient Self-Report; Patients; Performance; Persons; Pharmaceutical Preparations; Physicians; Process; Provider; Psychologist; Psychometrics; Questionnaires; Reporting; Research; Research Personnel; Retrieval; Sampling; Science; Scientist; Site; Surveys; Techniques; Test Result; Testing; Validity and Reliability; Work; antiretroviral therapy; clinical care; cohort; compliance behavior; effective intervention; electronic data; experience; improved; innovation; insight; medication compliance; novel; pill; preconditioning; public health relevance; response; tool

DESCRIPTION (provided by applicant): Despite the availability of one pill once daily treatment for HIV, poor adherence with HIV antiretroviral therapy (ART) clearly continues to be widespread. It is also clear that non-infectious comorbidity such as diabetes and cardiovascular disease is increasingly common in persons with HIV, and that medications required for these other conditions further complicate patients' adherence efforts. Unfortunately, clinicians and researchers have yet to develop inexpensive and accurate methods to diagnose medication adherence problems. Objective methods such as electronic data monitoring are expensive and impractical in clinical care, and there are few well-tested, standardized, accurate methods for self report of medication adherence. Our inability to accurately assess adherence by self report is an important problem, because until we can accurately diagnose adherence problems, for all of a patient's medications, it will not be possible to focus interventions to improve adherence on those who most need them. The long term goal of this research is to link the accurate and timely diagnosis of medication adherence problems with customized treatments that are patient and medication specific. The overall objective of this application, which is the next step toward attainment of our long term goal, is to develop a small set of well-tested items that can be used by clinicians and researchers to diagnose medication adherence problems in persons with HIV. Our central hypothesis is that patients usually cannot remember individual dosing events when they self-report, they estimate. We argue that the rigorous cognitive testing that we plan will produce questionnaire items that are congruent with the actual cognitive processes which patient use to recall and report adherence events, and will thus be optimally accurate. The rationale for choosing this approach is that that the application of methods used by psychologists and cognitive scientists to understand how information is encoded and recalled will provide new insights to the science of medication self-report, and provide important new tools for both clinicians and researchers. The proposed research is relevant to the NIH's mission poor adherence with medications for chronic conditions like HIV is a serious, worldwide problems, and because the accurate identification of medication adherence problems is a precondition for efficient and effective intervention. Guided by strong preliminary data, this R01 proposal has three specific aims: 1) Use in depth cognitive testing to develop optimal medication self-report item sets, 2) Conduct psychometric testing, and 3) Conduct construct validity testing. The approach is innovative because rigorous cognitive testing has not yet been used to optimize the quality of adherence self-report. The proposed research is significant because valid, standardized items for the self-report of medication adherence, across all of a patient's medications, are critically needed for both clinical care and research. Although this proposal focuses on persons with HIV disease, because our testing will focus both on ART and on other non-ART medications, our findings should be generalizable to all persons with chronic conditions. PUBLIC HEALTH RELEVANCE: Achieving optimal health outcomes for persons with HIV requires that they adhere not only with antiretroviral medications, but also with medications for non-infectious conditions such as diabetes. We propose to develop and validate a small set of self-report items that can be used to identify persons with adherence problems so that they can be efficiently targeted for interventions. Although this proposal focuses on persons with HIV disease, the items we develop should be usable for adherence assessment for medications for persons with any chronic condition.

描述（由申请人提供）：尽管艾滋病毒每日一次治疗可获得一片药，但艾滋病毒抗逆转录病毒治疗（ART）的依从性差显然仍然普遍存在。同样清楚的是，非传染性合并症，如糖尿病和心血管疾病，在艾滋病毒感染者中越来越常见，而这些其他疾病所需的药物使患者的依从性进一步复杂化。不幸的是，临床医生和研究人员尚未开发出廉价而准确的方法来诊断药物依从性问题。电子数据监测等客观方法在临床护理中昂贵且不切实际，而且很少有经过良好测试的、标准化的、准确的药物依从性自我报告方法。我们无法通过自我报告准确地评估依从性是一个重要的问题，因为除非我们能够准确地诊断出依从性问题，对于所有病人的药物，我们不可能集中干预措施来提高那些最需要药物的人的依从性。这项研究的长期目标是将药物依从性问题的准确及时诊断与患者和药物特定的定制治疗联系起来。这个应用程序的总体目标，是我们实现长期目标的下一步，是开发一套经过良好测试的项目，可以被临床医生和研究人员用来诊断艾滋病毒感染者的药物依从性问题。他们估计，我们的中心假设是，患者在自我报告时通常记不住个别给药事件。我们认为，我们计划的严格认知测试将产生与患者用于回忆和报告依从性事件的实际认知过程一致的问卷项目，从而达到最佳准确性。选择这种方法的基本原理是，心理学家和认知科学家用来理解信息是如何编码和回忆的方法的应用将为药物自我报告科学提供新的见解，并为临床医生和研究人员提供重要的新工具。这项拟议的研究与美国国立卫生研究院的使命有关，治疗艾滋病等慢性疾病的药物依从性差是一个严重的全球性问题，因为准确识别药物依从性问题是有效干预的先决条件。在充分的初步数据指导下，本R01建议有三个具体目标：1)利用深度认知测试开发最佳药物自我报告项目集；2)进行心理测量测试；3)进行结构效度测试。该方法具有创新性，因为严格的认知测试尚未被用于优化依从性自我报告的质量。这项拟议的研究意义重大，因为临床护理和研究都迫切需要有效的、标准化的药物依从性自我报告项目，涵盖所有患者的药物。虽然这项建议的重点是艾滋病毒感染者，但由于我们的测试将集中在抗逆转录病毒治疗和其他非抗逆转录病毒治疗药物上，我们的发现应该可以推广到所有患有慢性疾病的人。