Development of a novel medication adherability tool to improve cardiovascular disease management

近一半的心脏病患者在一年内不遵守规定的治疗 治疗开始。这是为什么心血管疾病仍然是主要的和可改变的原因 美国的死因。尽管许多人试图开发旨在提高依从性的干预措施， 这些尝试取得了不同的、往往是有限的成功;一种解释可能是， 遵守的问题没有得到解决。那些成功的干预措施往往使药物 但实施起来往往很昂贵，或者部署得太晚。开发新的供应商- 面临修改药物"粘附性"的干预，粘附性定义为药物的性质， 它们对患者来说很难服用，可能特别有效，而且相对便宜。例如更 超过30%的患者报告难以吞咽处方药，但很少有人知道这是如何发生的。 "粘附性"影响长期依从性和临床结果，很少有干预措施关注这些问题。 为此，Lauffenburger博士的K01提案采用了一种新颖的预防性、以患者为中心的方法 为心血管疾病管理提供行为改变。供应商往往不知道 他们开的药实际上看起来像什么，或者药物的哪些方面是可以接受的或首选的 他们的病人。这项研究将独特地纳入患者对药物性质的看法， 在可扩展的面向提供者的临床决策支持干预的设计中的依从性差。 其目标是：（1）建立一个全面的心血管药物框架 可能导致患者依从性差的性质，如外观、副作用特征或给药 焦点小组;（2）在大型国家数据中严格评估其对依从性和临床结局的影响 来源;（3）开发和外部验证药物粘附性的新临床预测规则;以及（4） 根据预测，开发和试点测试基于网络和电子健康记录的新型处方工具 供应商规则这一创新提案的预期总体影响是，它将从根本上推进 如何为患者提供个性化的药物治疗，以最终提高依从性和健康结果。 Lauffenburger博士作为一名接受过流行病学培训的执业药剂师，拥有独特的背景， 致力于研究。该提案包括一项教育计划，将解决她的差距， 培训：行为科学、预测建模和实施研究方面的专业知识。营商友导 一个由遵守和执行方面的专家Niteesh Choudhry领导的小组， 心血管试验（Elliott Antman，共同导师），生物统计学（Robert Glynn，共同导师）和行为 科学（丹尼尔所罗门，共同导师），并将确保科学的成功和培训。通过这一结论， 计划，她将能够独立设计，目标，并评估行为干预心脏 疾病建议的K01的结果将是一个计划的R01级应用程序的宝贵的试点工作。

Nearly half of patients with heart disease become non-adherent to their prescribed therapies within a year of treatment initiation. This is a central and modifiable reason why cardiovascular disease remains a leading cause of death in the US. Despite numerous attempts to develop interventions aimed at improving adherence, these attempts have had varying and often limited success; one explanation could be that underlying barriers to adherence are not being addressed. Those interventions that have been successful often make medications easier to take but are frequently expensive to implement or deployed too late. Developing a novel provider- facing intervention that modifies medication “adherability”, defined as the properties of medications that make them difficult for patients to take, could be especially impactful and relatively inexpensive. For example, more than 30% of patients report difficulties swallowing prescribed medicines, yet little is known how this “adherability” affects long-term adherence and clinical outcomes, and few interventions focus on these issues. To this end, Dr. Lauffenburger’s K01 proposal incorporates a novel prophylactic, patient-centric approach to provider behavior change for cardiovascular disease management. Providers often do not know what the medications they prescribe actually look like or what aspects of the medications are acceptable to or preferred by their patients. This study will uniquely incorporate patient perspectives about medication properties that lead to poor adherence in the design of a scalable provider-facing clinical decision support intervention. The proposed aims are to: (1) develop a comprehensive framework of cardiovascular medication properties, such as appearance, side-effect profiles, or dosing, that may lead to poor adherence using patient focus groups; (2) rigorously evaluate their effects on adherence and clinical outcomes in large national data sources; (3) develop and externally validate a novel clinical prediction rule for medication adherability; and (4) develop and pilot test novel web- and electronic health record-based prescribing tools based on the prediction rule for providers. The expected overall impact of this innovative proposal is that it will fundamentally advance how to personalize medications for patients to ultimately improve adherence and health outcomes. Dr. Lauffenburger has a unique background as a practicing pharmacist trained in epidemiology with a proven commitment to research. This proposal includes an educational plan that will address gaps in her training: expertise in behavioral sciences, prediction modeling, and implementation research. The mentorship team, led by Niteesh Choudhry, an expert in adherence and implementation, includes well-known experts in cardiovascular trials (Elliott Antman, co-mentor), biostatistics (Robert Glynn, co-mentor), and behavioral sciences (Daniel Solomon, co-mentor), and will ensure scientific success and training. By the conclusion of this program, she will be able to independently design, target, and evaluate behavioral interventions for heart diseases. The results of the proposed K01 will be invaluable pilot work for a planned R01-level application.