A Family-Focused, Literacy-Sensitive Intervention to Improve Medication Adherence

描述（由申请人提供）：这个以患者为导向的指导研究职业发展奖将提高我的能力，实现我的长期职业目标，成为心力衰竭（HF）领域的独立心血管护理研究员。这将使我能够开发和测试干预措施，以改善心衰患者的药物依从性和健康结果，特别是健康素养较低的患者。心力衰竭是一个严重的公共问题。高达50%的患者在出院后6个月内因心衰加重再次入院。心衰的自然史可以通过适当的治疗来改变，但要实现这一益处，坚持用药是必不可少的。目前，约50%的心衰患者药物依从性不理想，其严重后果包括频繁住院，给个人和社会带来巨大费用，以及生活质量差。一些干预措施改善了心衰患者的药物依从性，但干预完成后其效果下降。因此，需要一种新的方法。我的指导团队(dr。Michael Pignone, Sandra Dunbar, Darren DeWalt， Carol Golin和George Knafl)和我制定了一个综合的培训计划，包括工作坊，短期课程和研讨会，以及一个研究项目，这将为我的研究生涯做好准备，重点是提高心力衰竭患者的药物依从性。在K23奖的拟议项目中，我将试点测试一项以家庭为中心和对识字敏感的综合干预措施，该干预措施有可能有效地

DESCRIPTION (provided by applicant): This Mentored Patient-Oriented Research Career Development Award will enhance my ability to achieve my long-term career goal of becoming an independent cardiovascular nurse researcher in the area of heart failure (HF). It will allow me to develop and test interventions to improve medication adherence and health outcomes in patients with HF, especially patients with low health literacy. Heart failure is a serious public problem. Up to 50% of patients are readmitted within six months of discharge for HF exacerbations. The natural history of HF can be modified by appropriate therapy but medication adherence is essential to realize this benefit. About 50% of HF patients now have sub-optimal medication adherence with serious consequences including frequent hospitalizations, enormous expense to individuals and society, and poor quality of life. Several interventions have led to improved medication adherence in patients with HF, but, their effects decreased after completion of the intervention. Thus, there is a need for a new approach. My mentoring team (Drs. Michael Pignone, Sandra Dunbar, Darren DeWalt, Carol Golin, and George Knafl) and I have formulated a comprehensive training program of workshops, short courses, and seminars, and a research project that will prepare me for a research career focusing on improving medication adherence in HF. In the proposed project of the K23 award, I will pilot test an integrated family-focused and literacy-sensitive intervention that has the potential to effectively improve medication adherence in patients with HF and enable patients to sustain the improvement. A total of 36 HF patients with sub-optimal medication adherence and their family members will be randomized to intervention or usual care groups. If the study demonstrates the feasibility and efficacy of a clinically practical, nurse-delivered, family-focused and literacy-sensitive intervention to improve medication adherence in patients with HF, the next step will be to develop a larger, more definitive test of the intervention. Interventions to improve medication adherence may decrease the risk of hospitalization and death among patients with HF who have sub-optimal medication adherence.