mHealth for Diabetes Adherence Support

项目总结 许多患有糖尿病的非裔美国人和拉丁裔人没有达到推荐的糖尿病目标 使他们处于并发症的高风险中。以团队为基础的护理模式有助于实现治疗目标。 此外，移动健康(MHealth)技术可以进一步改善那些更难 伸手。这项研究将评估基于团队的mHealth干预措施的影响，旨在改善 坚持用药、健康饮食和体育锻炼行为。我们将比较这一mHealth 以惯常的谨慎态度接近。 临床药剂师和健康教练(HC)将提供我们建议的基于团队的干预。 移动健康服务包括手机短信、安全视频会议和HC家访。 药剂师将专注于药物调节和依从性。健康教练将帮助确定 以文化敏感的方式坚持的心理、社会和环境挑战。在一起，他们可以 协助设定目标、解决问题、就相互竞争的优先事项进行谈判，并提供社会支持 利用移动健康技术。 我们研究小组的初步数据支持健康教练与临床合作的作用- 以药剂师为基础，改善少数族裔的糖尿病结果。在拟议的移动健康干预中，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 对于许多低收入患者来说。此外，我们的试点工作表明，短信是一种更好的方式 交流，并可能促进与患者更频繁的接触。 我们提出了一项随机对照试验来评估mHealth糖尿病的有效性 临床药剂师和健康教练提供的依从性支持干预。我们将随机选择220个 通过UI Health向患者提供以下服务之一：(1)通过临床药剂师和 健康教练；或(2)常规护理。一年后，完成mHealth干预的患者将 在常规护理组接受mHealth方法的同时，再监测一年。结果包括 服药依从性、糖化血红蛋白、血压和低密度脂蛋白-胆固醇水平。具体目标包括： (1)评估由临床提供的mHealth糖尿病依从性支持干预的有效性 为非洲裔美国人和拉丁裔成年2型糖尿病患者提供药剂师和健康教练；(2) 评估一年后改善的糖尿病行为的维持情况和临床结果 完成干预；(3)评估mHealth糖尿病坚持的成本和成本-效果 与常规护理相比的支持；以及(4)评估mHealth的覆盖范围、采用和实施情况 基于RE-AIM框架的糖尿病坚持支持。

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.