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A Smartphone Intervention to Improve Adherence to Antipsychotic Medications

智能手机干预可提高抗精神病药物的依从性

基本信息

批准号：
8525456
负责人：
JULIE A. KREYENBUHL
金额：
$ 19.48万
依托单位：
UNIVERSITY OF MARYLAND BALTIMORE
依托单位国家：
美国
项目类别：
财政年份：
2011
资助国家：
美国
起止时间：
2011-08-15 至 2015-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8525456
关键词：
Adherence Adult Adverse effects American Antipsychotic Agents Asthma Behavior Behavioral Car Phone Cellular Phone Communication Computers Data Diabetes Mellitus Evaluation Exhibits Family Future Goals HIV Health Health Care Costs Healthcare Hospitalization Impairment Individual Internet Intervention Laboratories Lead Medical Medication Management Mental Health Minority Modeling Monitor Motivation National Institute of Mental Health Outcome Outcomes Research Participant Patients Perception Pharmaceutical Preparations Pharmacy facility Population Psychiatrist Randomized Recovery Relapse Relative (related person)Research Resources Risk Behaviors Schizophrenia Secure Self Management Societies Symptoms Technology Telephone Testing Vision adverse outcome base clinical practice digital flexibility improved medication compliance neuropsychological novel strategies pilot trial response severe mental illness shared decision making skills smoking cessation usability user centered design

项目摘要

DESCRIPTION (provided by applicant): Up to 60% of individuals with schizophrenia do not take their antipsychotic medications as prescribed, which can lead to symptom relapse, decreased functioning, hospitalization, and increased healthcare costs. Recent studies of both patient- and pharmacy-based interventions utilizing behavioral tailoring, environmental supports, and medication monitoring have shown promise in improving antipsychotic adherence. However, there is continued need for effective adherence-enhancing interventions (AEIs) that are less resource intensive and more widely accessible by the broad range of individuals in need of assistance with medication management. Over the last decade, technological advances in internet and cellular communication, including the emergence of mobile 'smartphones', have revolutionized the way our society communicates. Whereas a variety of mobile phone-based applications have been shown to be effective for improving health outcomes such as medication adherence for a number of medical conditions, few such applications have been developed for individuals with schizophrenia. Therefore, in response to NIMH PAR-09-173, we propose to develop and pilot test the effect of a mobile smartphone intervention, MedActive, on improving antipsychotic adherence among this population. We used the Information-Motivation-Behavioral (IMB) Skills Model of adherence as the theoretical framework to inform the conceptualization of MedActive. The IMB Skills Model posits that individuals who are well-informed and motivated to adhere will enact adherence-related behavioral skills that lead to adherence behaviors and favorable health outcomes. MedActive will provide personalized reminders to patients to take their antipsychotic medications as prescribed and will query them about their intentions to take the medication, the occurrence of side effects, and the presence of positive psychotic symptoms. Summaries of these ecological momentary assessments of adherence, symptoms, and side effects will be made available to the individual on the phone and to their psychiatrist through a secure, online clinician interface. Using an iterative user-centered design approach, the specific aims of this proposal are to (1) collaborate with individuals with schizophrenia, psychiatrists and an expert advisory group to develop the initial version of MedActive; (2) conduct laboratory usability testing and a short-term field trial in 10 individuals with schizophrenia and their psychiatrists to determine the preliminary acceptability and feasibility of MedActive in clinical practice; and (3) conduct a randomized pilot trial of MedActive compared to providing a smartphone alone in 40 individuals with schizophrenia and their psychiatrists to evaluate its effect on antipsychotic adherence. We will also explore whether psychiatric symptoms and neuropsychological impairments moderate the effect of MedActive on adherence. If shown to be effective, MedActive will introduce a paradigm shift in medication self-management by individuals with schizophrenia and in treatment monitoring by their clinicians.

描述（由申请人提供）：高达60%的精神分裂症患者不按规定服用抗精神病药物，这可能导致症状复发、功能下降、住院和医疗费用增加。最近的研究表明，基于患者和药物的干预措施，包括行为定制、环境支持和药物监测，都有望改善抗精神病药物的依从性。然而，仍然需要有效的依从性增强干预措施（AEIs），这种干预措施的资源密集程度较低，并且更广泛地为需要药物管理援助的广大个人所获得。在过去的十年中，互联网和蜂窝通信的技术进步，包括移动“智能手机”的出现，彻底改变了我们社会的沟通方式。尽管各种基于移动电话的应用程序已被证明对改善健康结果有效，例如对许多医疗条件的药物依从性，但为精神分裂症患者开发的此类应用程序很少。因此，为了响应NIMH PAR-09-173，我们建议开发和试点测试移动智能手机干预的效果，MedActive，以提高这一人群的抗精神病药物依从性。我们使用依附性的信息-动机-行为（IMB）技能模型作为理论框架，为MedActive的概念提供信息。IMB技能模型假设，信息充分且有动力坚持的个体将制定与坚持相关的行为技能，从而导致坚持行为和良好的健康结果。MedActive将为患者提供个性化的提醒，提醒他们按照处方服用抗精神病药物，并询问他们服用药物的意图、副作用的发生情况以及是否存在阳性精神病症状。这些对依从性、症状和副作用的生态瞬间评估的摘要将通过电话提供给个人，并通过安全的在线临床医生界面提供给他们的精神科医生。采用以用户为中心的迭代设计方法，该提案的具体目标是：(1)与精神分裂症患者、精神科医生和专家咨询小组合作开发MedActive的初始版本；(2)对10名精神分裂症患者及其精神科医生进行实验室可用性测试和短期现场试验，初步确定MedActive在临床实践中的可接受性和可行性；(3)对40名精神分裂症患者及其精神科医生进行MedActive与单独提供智能手机的随机对照试验，以评估其对抗精神病药物依从性的影响。我们还将探讨精神症状和神经心理障碍是否会缓和MedActive对依从性的影响。如果证明有效，MedActive将在精神分裂症患者的药物自我管理和临床医生的治疗监测方面引入范式转变。