Improving medication adherence among people with diabetes who are homeless

提高无家可归的糖尿病患者的药物依从性

• 批准号: 10225024
• 负责人: Katherine Diaz Vickery
• 金额: $ 5.56万
• 依托单位: HENNEPIN HEALTHCARE RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-03-28 至 2023-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10225024
• 关键词: Accident and Emergency department; Acute; Address; Adherence; Adult; Aftercare; Age; American; Appointment; Behavior Therapy; Behavioral; Behavioral trial; Cardiovascular Diseases; Caring; Cessation of life; Chronic; Chronic Disease; Clinic; Clinical; Collaborations; Communities; Complications of Diabetes Mellitus; Counseling; County; Data; Development; Development Plans; Diabetes Mellitus; Disadvantaged; Educational Materials; Environment; Ethnic Origin; Focus Groups; Food Access; Foundations; Frequencies; Funding; Future; General Population; Glucose; Glycosylated hemoglobin A; Goals; Grant; Group Interviews; Health; Health Care Costs; Health behavior; Healthcare; Healthcare Systems; Home environment; Homelessness; Hospital Departments; Hospitalization; Hospitals; Institutes; Insurance Coverage; Intervention; Interview; Kidney; Leadership; Learning; Link; Logistics; Manuals; Manuscripts; Measures; Medical Research; Medical center; Memory; Mental disorders; Mentors; Mentorship; Metabolic; Methods; Minnesota; Minority; Modeling; Moods; Motivation; Neighborhood Health Center; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Participant; Patient Self-Report; Patient-Focused Outcomes; Patients; Perception; Persons; Pharmaceutical Preparations; Pharmacy facility; Population; Positioning Attribute; Prevalence; Procedures; Protocols documentation; Provider; Psychosocial Assessment and Care; Public Health; Publications; Race; Randomized; Refrigeration; Research; Research Personnel; Risk; Shelter facility; Social support; Statistical Methods; Substance Use Disorder; Telephone; Testing; Training; Training Support; Translational Research; Universities; Visit; Vulnerable Populations; Work; Writing; arm; base; behavior test; career; career development; collaborative care; comorbidity; control trial; cost; design; diabetes management; diet and exercise; disparities in morbidity; disparity reduction; evidence base; experience; food insecurity; glycemic control; health care service utilization; health disparity; health record; housing instability; improved; innovation; insurance claims; medication compliance; meetings; member; modifiable behavior; mortality; motivational enhancement therapy; multidisciplinary; novel; peer; pilot trial; practice-based research network; preference; premature; professor; psychosocial; public health relevance; recruit; response; safety net; skills; standard care; supported housing; theories; therapy design; trend; vascular stress

PROJECT SUMMARY The long-term objective of this project is to reduce the diabetes health disparities of people with type 2 Diabetes who experience Homelessness, herein abbreviated as DH. The study will focus on diabetes medication adherence as a modifiable behavior known to correlate with glycemic control, all-cause mortality, all-cause hospitalization, and health care cost. The aims are to: (1) Develop the initial Diabetes Homeless Medication Support (D-Homes) treatment manual through focus groups with DH (N=30) at various levels of glycemic control (HgA1c<7, 7-9, >9) and interviews with their multi-disciplinary providers (N=12), (2) Test patient perceptions of the feasibility and acceptability of study procedures and refine the D-Homes treatment manual through test cases (n=10), and (3) Conduct a pilot randomized control trial (N=54) to compare the effect of D-Homes (weekly phone/in-person sessions over 12 weeks) vs. enhanced standard care (identify/reinforce care team, printed educational materials) on medication adherence, glycemic control, and health care utilization. These aims follow a sequential exploratory mixed methods approach. Qualitative focus groups and interviews will gather data about the values, preferences, and barriers to medication adherence faced by DH and their response to proposed intervention components. The initial protocol will be developed using existing evidence-based models and interventions to improve medication adherence, specifically the Information Motivation Behavioral Skills and Collaborative Care Models and use of motivational interviewing as a counseling style. It will also include explicit support for housing, food access, and other psychosocial needs. We will further tailor our protocol by conducting ten test cases. A final protocol will be developed by integrating qualitative and quantitative findings from Aims 1 and 2 with input from a multi-stakeholder panel with providers and community members with lived experience of these issues and the mentorship team. This project will prepare Dr. Vickery for a career as an independent investigator focused on overcoming diabetes and other health disparities among historically disadvantaged groups. Her career development plan includes training goals to: (i) develop tailored, theory-based behavioral interventions to address the needs of vulnerable groups using mixed methods data, (ii) learn to conduct rigorous behavioral trials and statistical methods for analyzing results, (iii) learn to develop and use measures of patient-centered outcomes and medication adherence, (iv) advanced manuscript and grant-writing skills. The research will be conducted in an ideal environment, Hennepin County Medical Center, the largest safety net health care system in the region, and its research arm, the Minneapolis Medical Research Foundation. It will be further strengthened by Dr. Vickery’s appointment as an Assistant Professor at University of Minnesota, a large academic health center with a Clinical Translational Sciences Institute. The interviews and trial will be conducted at shelters in close collaboration with Hennepin County Health Care for the Homeless clinics where Dr. Vickery works clinically.

项目摘要 该项目的长期目标是减少2型糖尿病患者的健康差异 无家可归的糖尿病患者，简称DH。这项研究将集中在糖尿病 药物依从性是一种可改变的行为，已知与血糖控制、全因死亡率 全因住院和医疗费用。其目的是：（1）发展最初的糖尿病无家可归者 药物支持（D-Homes）治疗手册，通过不同级别的DH焦点小组（N=30） 血糖控制（HgA 1c <7，7-9，>9）和与多学科提供者的访谈（N=12），（2）测试 患者对研究程序的可行性和可接受性的看法并完善D-Homes治疗 手动通过测试用例（n=10），和（3）进行初步随机对照试验（N=54），以比较 D-Homes（12周内每周电话/面对面会议）与加强标准护理的效果 （确定/加强护理团队，印刷教育材料）关于药物依从性、血糖控制和 卫生保健利用。这些目标遵循顺序探索性混合方法的方法。定性重点 小组和访谈将收集有关价值观、偏好和药物依从性障碍的数据， 以及他们对建议的干预措施的回应。将制定初始协议 使用现有的循证模型和干预措施来改善药物依从性，特别是 信息激励行为技能和协作护理模式以及使用激励性访谈作为 咨询风格。它还将包括对住房、粮食供应和其他心理社会需求的明确支持。 我们将通过进行10个测试用例来进一步定制我们的协议。最终的协议将通过整合 目标1和目标2的定性和定量结果，以及与供应商的多利益攸关方小组的投入 和社区成员与这些问题和导师团队的生活经验。该项目将 准备维克里博士的职业生涯作为一个独立的调查员，专注于克服糖尿病和其他 历史上处于不利地位的群体之间的健康差距。她的职业发展计划包括培训 目标是：㈠制定有针对性的、以理论为基础的行为干预措施，以满足弱势群体的需要 使用混合方法数据，（ii）学习进行严格的行为试验和统计方法进行分析 结果，（iii）学会制定和使用以患者为中心的结果和药物依从性的措施，（iv） 先进的手稿和赠款写作技巧。研究将在理想的环境中进行， 亨内平县医疗中心，该地区最大的安全网医疗保健系统，及其研究部门， 明尼阿波利斯医学研究基金会任命维克里博士为 明尼苏达大学的助理教授，这是一个大型学术健康中心，拥有临床翻译 科学研究所。访谈和试验将在收容所进行，并与Hennepin密切合作。 县卫生保健为无家可归的诊所，维克里博士临床工作。