mHealth for Diabetes Adherence Support

项目摘要 许多患有糖尿病的非洲裔美国人和拉丁美洲人没有达到推荐的糖尿病目标 使他们面临并发症的高风险。以团队为基础的护理模式可以帮助实现治疗目标。 此外，移动的健康（mHealth）技术可以进一步改善那些更难获得的人的结果。 到达。这项研究将评估基于团队的移动健康干预措施的影响， 药物依从性、健康饮食和身体活动行为。我们将比较这个mHealth 以平常的小心接近。 临床药师和健康教练（HC）将提供我们提出的基于团队的干预。 移动健康服务包括移动的电话短信、安全视频会议和卫生保健家访。 药剂师将专注于药物协调和依从性。健康教练将帮助确定 社会心理和环境挑战，以文化敏感的方式坚持。他们一起可以 协助制定目标、解决问题、协商优先事项，并提供社会支持 利用移动医疗技术。 我们研究小组的初步数据支持健康教练与诊所合作的作用- 基于药剂师在改善少数民族糖尿病的结果。在拟议的移动健康干预措施中，患者- 药剂师视频会议将消除与药剂师面对面访问的需要，这是不切实际的 对于许多低收入的患者来说。此外，我们的试点工作表明，短信是一种更可取的手段， 这可能有助于更频繁地与患者接触。 我们提出了一项随机对照试验，以评估mHealth糖尿病的有效性。 由临床药师和健康教练提供的依从性支持干预。我们将随机抽取220名 患者通过UI健康：（1）mHealth糖尿病依从性支持通过临床药剂师和 健康教练;或（2）日常护理。一年后，完成mHealth干预的患者将 在普通护理组接受移动健康方法的同时，再监测一年。成果包括 药物依从性、血红蛋白A1 c、血压和LDL胆固醇水平。具体目标包括： (1)评估由临床医生提供的移动健康糖尿病依从性支持干预的有效性 药剂师和健康教练，以非洲裔美国人和拉丁美洲成年人与不受控制的2型糖尿病;（2） 评估改善的糖尿病行为的维持以及一年后的临床结果 完成干预;（3）评估mHealth糖尿病依从性的成本和成本效益 与常规护理相比的支持;（4）评估移动健康的覆盖范围，采用和实施 基于RE-AIM框架的糖尿病依从性支持。

PROJECT SUMMARY Many African-Americans and Latinos with diabetes do not achieve recommended diabetes goals placing them at high risk for complications. Team-based models of care can help in reaching goals of therapy. Additionally, mobile health (mHealth) technologies can further improve outcomes among those more difficult to reach. This study will evaluate the impact of a team-based, mHealth intervention designed to improve medication adherence, healthy eating, and physical activity behaviors. We will compare this mHealth approach with usual care. Clinical pharmacists and health coaches (HC) will deliver our proposed team-based intervention. mHealth delivery includes mobile phone text messaging, secure videoconferencing, and HC home visits. Pharmacists will focus on medication reconciliation and adherence. Health coaches will help identify psychosocial and environmental challenges to adherence in a culturally-sensitive manner. Together, they can assist in goal-setting, problem-solving, negotiation of competing priorities, and provide social support leveraging mHealth technologies. Preliminary data from our research group supports the role of health coaches partnering with clinic- based pharmacists in improving diabetes outcomes in minorities. In the proposed mHealth intervention, patient- pharmacist videoconferencing will eliminate the need for in-person visits with a pharmacist, which is impractical for many low-income patients. In addition, our pilot work suggests that text messaging is a preferable means of communication and may facilitate more frequent contact with patients. We propose a randomized, controlled trial to evaluate the effectiveness of an mHealth diabetes adherence support intervention delivered by clinical pharmacists and health coaches. We will randomize 220 patients through UI Health to either: (1) mHealth diabetes adherence support through clinical pharmacists and health coaches; or (2) usual care. After one year, patients completing the mHealth intervention will be monitored for an additional year while the usual care group receives the mHealth approach. Outcomes include medication adherence, hemoglobin A1c, blood pressure, and LDL-cholesterol levels. The specific aims include: (1) evaluate the effectiveness of an mHealth diabetes adherence support intervention delivered by clinical pharmacists and health coaches to African-American and Latino adults with uncontrolled type 2 diabetes; (2) evaluate the maintenance of improved diabetes behaviors as well as clinical outcomes one year after completing the intervention; (3) evaluate the cost and cost-effectiveness of mHealth diabetes adherence support compared to usual care; and (4) evaluate the reach, adoption, and implementation of mHealth diabetes adherence support based on the RE-AIM framework.