Helping the helpers: User-centered technology to aid caregiver management of medications for people with ADRD

项目摘要 在美国近600万阿尔茨海默病和相关痴呆症（ADRD）患者中， 美国依赖于非正式的（家人和朋友）照顾者来帮助管理他们的药物。合并症 在ADRD患者中高度流行，通常需要同时使用多种药物 和复杂的药物治疗方案。护理人员往往未经培训，资源不足，没有支持， 执行ADRD患者依赖的药物治疗任务。研究报告称， 药物管理与照顾者的负担和压力有关， 三分之一的ADRD患者使用药物。不幸的是，大多数护理人员支持干预措施并不 解决ADRD护理人员在管理ADRD患者药物方面的作用。此外，少数 针对ADRD护理人员的药物干预措施并没有利用信息技术（IT）， 国家承认信息技术在ADRD护理和康复中的重要作用。为了弥补这一差距， 一个拟议的项目是开发一种基于信息技术的干预措施，以支持护理人员为人们管理药物 关于ADRD根据NIH阶段模型，必须建立包括IT解决方案在内的行为干预措施 可靠的经验记录因此，我们建议采用以用户为中心的设计的三个阶段， 解决NIH阶段模型的前两个阶段。首先，我们将使用以用户为中心的设计相结合 对管理药物的ADRD护理人员进行用户需求评估（第0阶段）的方法， ADRD患者。其次，我们将使用参与式协同设计（阶段IA）来协同设计原型IT 与ADRD护理人员合作进行干预，支持护理人员辅助的药物管理。 第三，我们会进行使用者测试（第IB阶段），以测试以ADRD进行信息技术介入的原型的可行性 照顾者以用户为中心的设计是黄金标准（例如，FDA对所有医疗器械的强制要求） 通过让最终用户群体的代表参与设计产品，以更好地满足用户需求。 目标的完成将导致一项混合疗效/有效性第3阶段随机临床试验， 干预，检验药物依从性和安全性的变化，次要结局为 神经精神症状，急性护理利用和照顾者负担。

PROJECT SUMMARY A majority of the nearly 6 million people living with Alzheimer's disease and related dementias (ADRD) in the US are reliant upon informal (family and friend) caregivers to help manage their medications. Comorbidities are highly prevalent in people with ADRD, often requiring the management of multiple simultaneous medications and complex medication regimens. Caregivers are often untrained, under-resourced, and unsupported to perform the medication tasks people with ADRD rely upon. Studies have reported that caregiver-assisted medication management is associated with caregiver burden and stress and potentially inappropriate medication use in a third of people with ADRD. Unfortunately, most caregiver support interventions do not address ADRD caregivers' roles in managing medications for people with ADRD. Moreover, the few interventions for ADRD caregivers addressing medications do not leverage information technology (IT), despite national recognition of IT's vital role in ADRD care and caregiving. To address this gap, the intent of the proposed project is to develop an IT-based intervention to support caregivers managing medications for people with ADRD. According to the NIH Stage Model, behavioral interventions including IT solutions must be built upon a solid empirical record. Therefore, we propose to employ the three phases of user-centered design to address the first two stages of the NIH Stage Model. First, we will use a combination of user-centered design methods to conduct a user needs assessment (Stage 0) of ADRD caregivers who manage medications for people with ADRD. Second, we will use participatory co-design (Stage IA) to co-design a prototype IT intervention to support caregiver-assisted medication management collaboratively with ADRD caregivers. Third, we will conduct user testing (Stage IB) to feasibility test the prototype IT intervention with ADRD caregivers. User-centered design is the gold standard (e.g., FDA-mandated for all medical devices) process for designing products by involving representatives of the end-user population to better address user needs. Completion of the aims will lead to a hybrid efficacy/effectiveness Stage 3 randomized clinical trial of the intervention, powered to test changes in medication adherence and safety, with secondary outcomes of neuropsychiatric symptoms, acute care utilization, and caregiver burden.