Development of a novel medication adherability tool to improve cardiovascular disease management

开发新型药物依从性工具以改善心血管疾病管理

• 批准号: 9886260
• 负责人: Julie Christine Lauffenburger
• 金额: $ 14.36万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-04-17 至 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9886260
• 关键词: Address; Adherence; Adopted; Affect; Appearance; Behavior Therapy; Behavioral Sciences; Biometry; Cardiovascular Diseases; Cardiovascular system; Cause of Death; Characteristics; Clinical; Color; Consumption; Data; Data Sources; Decision Making; Deglutition; Development; Disease; Disease Management; Dose; Electronic Health Record; Ensure; Epidemic; Epidemiology; Focus Groups; Frequencies; Future; Goals; Health; Heart Diseases; Internet; Intervention; Lead; Machine Learning; Medicine; Mentors; Mentorship; Methods; Mission; National Heart, Lung, and Blood Institute; Outcome; Outpatients; Palate; Patients; Pharmaceutical Preparations; Pharmacists; Property; Provider; Regimen; Reporting; Research; Review Literature; Risk; Route; Shapes; Testing; Time; Training; Work; base; behavior change; cardiometabolism; clinical decision support; clinical decision-making; design; health belief; implementation research; improved; individual patient; individualized medicine; innovation; medication compliance; mortality; novel; novel strategies; predictive modeling; programs; prophylactic; side effect; success; successful intervention; support tools; systematic review; theories; tool; virtual

Nearly half of patients with heart disease become non-adherent to their prescribed therapies within a year of treatment initiation. This is a central and modifiable reason why cardiovascular disease remains a leading cause of death in the US. Despite numerous attempts to develop interventions aimed at improving adherence, these attempts have had varying and often limited success; one explanation could be that underlying barriers to adherence are not being addressed. Those interventions that have been successful often make medications easier to take but are frequently expensive to implement or deployed too late. Developing a novel provider- facing intervention that modifies medication “adherability”, defined as the properties of medications that make them difficult for patients to take, could be especially impactful and relatively inexpensive. For example, more than 30% of patients report difficulties swallowing prescribed medicines, yet little is known how this “adherability” affects long-term adherence and clinical outcomes, and few interventions focus on these issues. To this end, Dr. Lauffenburger’s K01 proposal incorporates a novel prophylactic, patient-centric approach to provider behavior change for cardiovascular disease management. Providers often do not know what the medications they prescribe actually look like or what aspects of the medications are acceptable to or preferred by their patients. This study will uniquely incorporate patient perspectives about medication properties that lead to poor adherence in the design of a scalable provider-facing clinical decision support intervention. The proposed aims are to: (1) develop a comprehensive framework of cardiovascular medication properties, such as appearance, side-effect profiles, or dosing, that may lead to poor adherence using patient focus groups; (2) rigorously evaluate their effects on adherence and clinical outcomes in large national data sources; (3) develop and externally validate a novel clinical prediction rule for medication adherability; and (4) develop and pilot test novel web- and electronic health record-based prescribing tools based on the prediction rule for providers. The expected overall impact of this innovative proposal is that it will fundamentally advance how to personalize medications for patients to ultimately improve adherence and health outcomes. Dr. Lauffenburger has a unique background as a practicing pharmacist trained in epidemiology with a proven commitment to research. This proposal includes an educational plan that will address gaps in her training: expertise in behavioral sciences, prediction modeling, and implementation research. The mentorship team, led by Niteesh Choudhry, an expert in adherence and implementation, includes well-known experts in cardiovascular trials (Elliott Antman, co-mentor), biostatistics (Robert Glynn, co-mentor), and behavioral sciences (Daniel Solomon, co-mentor), and will ensure scientific success and training. By the conclusion of this program, she will be able to independently design, target, and evaluate behavioral interventions for heart diseases. The results of the proposed K01 will be invaluable pilot work for a planned R01-level application.

近一半的心脏病患者在一年内不遵守处方疗法 开始治疗的时间。这是心血管疾病仍然是主要的和可修改的原因。 在美国的死因。尽管多次尝试制定旨在提高遵从性的干预措施， 这些尝试取得了各种不同的、往往有限的成功；一种解释可能是潜在的障碍 对坚守的问题没有得到解决。那些成功的干预措施往往会产生药物效应。 更容易实施，但实施成本往往很高，或者部署得太晚。开发一种新的提供商- 面对改变药物“粘附性”的干预，粘附性被定义为使药物 它们对患者来说很难服用，可能特别有效，而且相对便宜。例如，更多 超过30%的患者报告吞咽处方药有困难，但很少有人知道这是如何发生的 “依从性”影响长期依从性和临床结果，很少有干预措施关注这些问题。 为此，Lauffenburger博士的K01建议采用了一种新的预防方法，即以患者为中心 为心血管疾病管理提供行为改变。提供商通常不知道 他们开的药物实际上看起来像什么，或者药物的哪些方面是可以接受的或首选的 被他们的病人。这项研究将独一无二地纳入患者对药物属性的看法，这些属性导致 由于在设计可扩展的面向提供商的临床决策支持干预方面坚持较差。 建议的目标是：(1)开发一个全面的心血管药物框架 可能导致患者依从性差的特性，如外观、副作用配置文件或剂量 重点小组；(2)在国家大数据中严格评估其对依从性和临床结局的影响 资料来源；(3)开发和外部验证新的药物依从性临床预测规则；以及(4) 在预测的基础上开发和试运行基于网络和电子健康记录的新型处方工具 提供程序的规则。这一创新提议的预期总体影响是，它将从根本上推进 如何为患者个性化用药，以最终改善依从性和健康结果。 Lauffenburger博士具有独特的背景，是一名受过流行病学培训的执业药剂师 对研究的承诺得到了证实。这项建议包括一项教育计划，将解决她的差距 培训：行为科学、预测建模和实施研究方面的专业知识。导师制 由遵守和实施专家Niteesh Choudhry领导的团队包括 心血管试验(Elliott Antman，共同导师)、生物统计学(Robert Glynn，共同导师)和行为 科学(丹尼尔·所罗门，共同导师)，并将确保科学成功和培训。以此为结论 计划，她将能够独立设计，目标，和评估心脏的行为干预 疾病。拟议的K01的结果将是计划中的R01级应用程序的宝贵试点工作。