Improving Hypertension Medication Adherence for Older Adults

提高老年人高血压药物的依从性

• 批准号: 9884987
• 负责人: Jeannie Kim Lee
• 金额: $ 62.34万
• 依托单位: UNIVERSITY OF ARIZONA
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-02-26 至 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9884987
• 关键词: Adherence; Adopted; Age; Algorithms; Behavior; Blood Pressure; Blood Pressure Monitors; Brain; Cellular Phone; Cognitive; Competence; Cues; Custom; Databases; Discipline of Nursing; Dose; Education; Effectiveness; Elderly; Enhancement Technology; Ensure; Feedback; Fostering; Funding; Health Care Costs; Healthcare; Heart; Heart failure; High Prevalence; Hypertension; Independent Living; Individual; Individual Differences; Instruction; Intervention; Intervention Studies; Kidney; Label; Measures; Mediation; Monitor; Motivation; Myocardial Infarction; Optics; Outcome; Participant; Pattern; Personal Autonomy; Persons; Pharmaceutical Preparations; Population; Process; Protocols documentation; Quality of life; Randomized; Randomized Controlled Trials; Reporting; Resources; Retina; Risk; Schedule; Self Blood Pressure Monitoring; Self Determination; Self Management; Short-Term Memory; Stroke; Support System; System; Technology; Testing; Time; Translating; Visualization; Wireless Technology; adverse outcome; base; blood pressure medication; blood pressure regulation; cardiovascular risk factor; cognitive ability; cognitive change; cognitive function; cognitive process; design; efficacy testing; evidence base; executive function; experience; handheld mobile device; health management; hypertension control; improved; improved outcome; medication compliance; mobile application; optical imaging; preservation; primary outcome; prospective memory; psychologic; secondary outcome; sex; technology development; theories; tool; usability; user-friendly

PROJECT SUMMARY / ABSTRACT Blood pressure (BP) medications are remarkably effective in reducing adverse outcomes of uncontrolled hypertension, and optimal adherence reduces heart failure, stroke, and myocardial infarction, and maintains cognitive function. Hypertension is especially prevalent in older adults (~67%), but BP mediation benefits are unrealized for many older adults, as nonadherence is ~50%, leading to decreased quality of life and high health care costs ($290 billion/year in US). We developed the theory-based Multifaceted Prospective Memory Intervention (MPMI), which significantly improved older adults' adherence to BP medications, but benefits did not sustain, once nursing support was removed. We thus developed the Medication Education, Decision Support, Reminding, and Monitoring System (MEDSReM) mobile application (App), which changes medication taking from an effortful process dependent on executive functions and cognitive processes that decline with age, to customized, cue-driven associative processes that are mostly preserved with age. MEDSReM-2 will capitalize on technological advances to integrate additional functionalities to MEDSReM including electronic BP monitoring and provide feedback about the relationship between medication adherence and BP. We will test the efficacy of MEDSReM-2, and expect that the evidence-based and multi-dimensional approach will increase perceived competence and autonomy, resulting in higher and sustained medication adherence and improved BP levels for nonadherent older adults (≥ 65 years), who self-manage at least one hypertension medication. The aims are: Aim 1: Advance the design of MEDSReM-2, an integrated mobile application that provides education, decision support, reminders, and monitoring to incorporate feedback on adherence related to BP measures. This aim will include implementing and testing new functionalities (e.g., electronic BP monitoring, optical image capture of labels to self-start the App, expanded decision support), as well as user- tested instructional protocols. Aim 2: Determine the efficacy and scalability of MEDSReM-2 through a randomized controlled trial (RCT) to assess efficacy as well as individual patterns of adherence and system use over time. We will screen 448 older people with hypertension to identify 224 nonadherent, randomized to a 6-month intervention study. The primary outcome will be improved adherence (n=112) versus an education control (n=112). Secondary outcomes will be BP, autonomy and competence, and mobile device proficiency. We will examine change in adherence over time in individual participants and moderators of sustainability, and evaluate MEDSReM-2 use patterns to assess factors related to improved adherence and BP management. Successful completion of these aims will result in a theory-based, technology-enhanced comprehensive self- management system that supports hypertension medication adherence and BP management for older adults. MEDReM-2 will foster self-management, through greater personal autonomy and competence, with potential to reduce hypertension-associated risks, save healthcare dollars, and promote independent living of older adults.

项目概要/摘要 血压 (BP) 药物对于减少失控的不良后果非常有效 高血压和最佳依从性可减少心力衰竭、中风和心肌梗死，并维持 认知功能。高血压在老年人中尤其普遍（~67%），但血压调节的益处是 许多老年人没有意识到这一点，因为不依从的比例约为 50%，导致生活质量下降和高 医疗保健费用（美国每年 2900 亿美元）。我们开发了基于理论的多方面前瞻性记忆 干预 (MPMI)，显着提高了老年人对血压药物的依从性，但益处并没有减少 一旦护理支持被移除，就无法维持。因此，我们开发了药物教育、决策 支持、提醒和监控系统 (MEDSReM) 移动应用程序 (App)，用于更改药物 依赖于执行功能和认知过程的努力过程，这些过程会随着执行功能和认知过程的下降而下降 年龄，到定制的、线索驱动的联想过程，这些过程大多随着年龄的增长而保留。 MEDSReM-2 将 利用技术进步将附加功能集成到 MEDSReM，包括电子 血压监测并提供有关药物依从性和血压之间关系的反馈。我们将 测试 MEDSReM-2 的功效，并期望基于证据的多维方法将 提高感知能力和自主权，从而提高和持续的药物依从性 改善自我管理至少一种高血压、不依从的老年人（≥ 65 岁）的血压水平 药物。目标是： 目标 1：推进 MEDSReM-2 的设计，这是一款集成移动应用程序， 提供教育、决策支持、提醒和监控，以纳入与遵守相关的反馈 血压测量。这一目标将包括实施和测试新功能（例如电子血压计） 监控、标签的光学图像捕获以自启动应用程序、扩展的决策支持）以及用户 经过测试的教学协议。目标 2：通过评估确定 MEDSReM-2 的功效和可扩展性 随机对照试验（RCT）评估疗效以及个体依从性和系统模式 随着时间的推移使用。我们将对 448 名患有高血压的老年人进行筛查，以确定 224 名不依从者，并随机分配到一组 6个月的干预研究。与教育相比，主要结果是提高依从性 (n=112) 对照（n=112）。次要结果是 BP、自主性和能力以及移动设备熟练程度。 我们将研究可持续发展的个体参与者和调节者随时间推移的坚持变化，以及 评估 MEDSReM-2 使用模式来评估与改善依从性和血压管理相关的因素。 成功完成这些目标将产生一个以理论为基础、以技术为基础的综合性自我 支持老年人高血压药物依从性和血压管理的管理系统。 MEDReM-2 将通过更大的个人自主权和能力来促进自我管理，并有潜力 降低与高血压相关的风险，节省医疗费用，并促进老年人的独立生活。