Leveraging Patient Portals to Improve Medication Adherence in Type 2 Diabetes

描述（由申请人提供）：对于糖尿病患者，降糖药（GLA）可改善血糖控制（HbA1c），预防疾病相关并发症和过早死亡。为了获得这些益处，患者必须遵守处方方案，研究表明依从性很差，口服GLAs的依从性从36%到85%不等；然而，很少有使用胰岛素的患者报告依从性差。可利用现有技术（如手机、互联网提醒、患者门户网站）向糖尿病患者提供药物依从性提醒和支持，从而改善临床结果。该提案描述了一个职业发展计划，将准备首席研究员（PI）作为一个成功的独立研究者，可以利用各种技术来设计和评估糖尿病自我保健干预措施。该提案描述了一项研究策略，其中PI将使用范德比尔特的患者门户网站（PWP）来提供基于理论的GLA依从性促进干预。作为一名接受过健康行为改变培训的社会/健康心理学家，私家侦探将通过本课程获得开发和使用技术的补充新技能。PI的直接目标是使用PWP向糖尿病患者提供以信息-动机-行为技能（IMB）为重点的GLA依从性干预。为了实现这一目标，PI提出了一项职业发展计划，该计划将先进的教学课程、参与地方和国家会议/研讨会/讲习班/会议、有指导的研究经历以及积极参与一个非常支持性的研究环境结合起来。该环境包括NIDDK资助的糖尿病研究和培训中心（DRTC），全国知名的生物医学信息部，最先进的患者PWP， NIH资助的CTSA，卫生服务研究中心（CHSR）和有效健康沟通计划（EHC）。该研究的具体目标是：(1)对糖尿病患者和提供者进行启发式研究，以确定使用PWP和其他技术进行糖尿病和药物管理的障碍；(2)通过现有的PWP设计GLA依从性干预措施，测试糖尿病患者的可用性，并在评估前完善干预措施；(3)进行一项随机对照试验，以测试干预对3个月和6个月时依从性和HbA1c多项指标的影响。此外，PI将测试干预是否增强了基于IMB模型的依从性行为的关键决定因素，以及IMB元素的变化是否映射到依从性和HbA1c的改善。最后，PI将测试IMB要素对依从性影响的潜在调节因子。在拟议的研究中利用技术将增加PI在行为改变干预措施的设计和评估方面的现有培训。最重要的是，这将加速她作为一名成功的独立研究者的职业生涯，她有能力设计和评估前沿的、理论基础的干预措施，这些干预措施广泛应用于糖尿病行为研究和临床护理领域。

DESCRIPTION (provided by applicant): For patients with diabetes, glucose lowering agents (GLA) improve glycemic control (HbA1c), and prevent disease-related complications, and premature death. Patient adherence to prescribed regimens is necessary to reap these benefits, and studies suggest adherence is poor, ranging from 36% to 85% adherence to oral GLAs; however, fewer patients using insulin report poor adherence. Existing technologies (e.g., cell phones, Internet reminders, patient web portals) could be leveraged to provide medication adherence reminders and support to patients with diabetes and, in turn, improve clinical outcomes. This proposal describes a career development plan that will prepare the principal investigator (PI) for success as an independent investigator who can leverage various technologies to design and evaluate diabetes self-care interventions. The proposal describes a research strategy in which the PI will use Vanderbilt's patient web portal (PWP) to deliver a theory-based GLA adherence promotion intervention. As a social/health psychologist with training in health behavior change, the PI will acquire complementary, new skills for developing and using technology through this K01. The PI's immediate goal is to use a PWP to deliver an Information-Motivation-Behavioral skills (IMB) focused GLA adherence intervention to patients with diabetes. To meet this goal, the PI has proposed a career development plan that integrates advanced didactic course work, participation in local and national meetings/seminars/workshops/conferences, a mentored research experience, and active involvement in an extremely supportive research environment. This environment includes an NIDDK funded Diabetes Research and Training Center (DRTC), nationally known Department of Biomedical Informatics, state-of-the-art patient PWP, NIH funded CTSA, Center for Health Services Research (CHSR), and Program on Effective Health Communication (EHC). The research specific aims are to: (1) conduct elicitation research with diabetes patients and providers to identify barriers to using a PWP and other technologies for diabetes and medication management; (2) design a GLA adherence intervention delivered via an existing PWP, test for usability with diabetes patients, and refine the intervention prior to evaluation; and (3) perform a randomized controlled trial to test the effect of the intervention on multiple measures of adherence and HbA1c at 3- and 6-months. In addition, the PI will test whether the intervention enhances critical determinants of adherence behavior based on the IMB model, and whether changes in IMB elements map onto improvements in adherence and HbA1c across time. Lastly, the PI will test potential moderators of the effect of the IMB elements on adherence. Leveraging technology in the proposed research will augment the PI's existing training in the design and evaluation of behavior change interventions. Most importantly, it will accelerate her career as a successful independent investigator well equipped to design and evaluate cutting-edge, theoretically grounded interventions with broad application to both the field of diabetes behavioral research and clinical care. PUBLIC HEALTH RELEVANCE: Behavioral informatics shows great promise in our current and future clinical and research climate. This K01 award will allow the PI to gain expertise in using technology to design, deliver and evaluate feasible and sustainable diabetes behavioral interventions.