Pharmacist-CHW Team to Improve Medication Adherence and Reduce Hypertension Disparities

药剂师-CHW 团队致力于提高用药依从性并减少高血压差异

基本信息

批准号：
10900852
负责人：
Jeannie Kim Lee
金额：
$ 8.1万
依托单位：
UNIVERSITY OF ARIZONA
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-09-06 至 2026-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10900852
关键词：
Address Adherence African American Automobile Driving Belief Blood Pressure Body mass index Cardiovascular Diseases Cardiovascular system Caring Cessation of life Chronic Disease Clinical Clinical Pharmacists Communities Community Health Aides Data Collection Death Rate Diagnosis Disparity Distal Dose Education Effectiveness Electronic Health Record Ethnic Population Face Fright Glycosylated hemoglobin A Health Health Insurance Health Services Accessibility Health behavior Healthcare Heart Diseases Hypertension Immigrant Individual Insurance Coverage Intention Intervention Kidney Diseases Latino Linguistics Low Income Population Low income Low-Density Lipoproteins Measures Medication Management Medicine Modeling Neighborhood Health Center Outcome Participant Patient Self-Report Patients Pharmaceutical Preparations Pharmacists Play Polypharmacy Population Heterogeneity Poverty Primary Care Qualifying Randomized Randomized, Controlled Trials Reduce health disparities Regimen Reporting Research Research Personnel Research Project Grants Resources Risk Factors Role Self Management Services Site Social Environment Social support Stroke Surveys Transportation Vietnamese Vulnerable Populations Waiting Lists Work accountable care organization adherence rate adverse outcome blood pressure control cardiovascular risk factor care coordination care providers caucasian American clinical practice comorbidity cost design disparity reduction effectiveness evaluation effectiveness testing ethnic disparity ethnic minority experience food insecurity health literacy high risk high risk population improved innovation low health literacy mathematical ability medication compliance member minority patient neglect patient navigator patient oriented pill post intervention premature prevent primary care provider programs racial disparity racial minority racial minority population racial population response skills social social culture theories

项目摘要

Abstract The U.S. faces profound racial and ethnic disparities in hypertension, which are exacerbated by disparities in medication adherence. Yet few existing medication adherence interventions are tailored to address the specific cultural beliefs of diverse populations who also face significant structural barriers to adherence associated with poverty, access to care and food insecurity. The proposed Improving Medication Adherence with Pharmacist and CHW Team (IMPaCT) intervention responds to the call for adherence interventions that are tailored for the specific needs of minority racial-ethnic groups. IMPaCT is a practice-based randomized controlled trial (RCT) to test the effectiveness of a comprehensive, individually- and culturally-tailored intervention for high-risk patients with hypertension, polypharmacy and low adherence. IMPaCT leverages the specialized expertise of a clinical pharmacist together with a community health worker (CHW) who will serve as cultural broker and patient navigator to address individual, clinical, social-cultural, and structural barriers to adherence. This comprehensive and tailored, coordinated care intervention aims to improve medication adherence and hypertension outcomes among African-American, Latino and Vietnamese immigrant patients. The proposed practice-based RCT is designed to meet the following specific aims: Aim 1: Implement IMPaCT, an innovative, tailored adherence intervention delivered by a pharmacist and CHW team. Aim 2: Determine the short- and long-term effectiveness of IMPaCT by assessing pre- to post-intervention changes in: a) medication adherence (proximal outcome) and blood pressure (BP, distal outcome), and b) other comorbid health outcomes (e.g., HbA1c, BMI) using a randomized controlled trial. Aim 3: Identify factors associated with IMPaCT effectiveness including: a) tailored intervention features, b) medication beliefs, c) barriers to adherence, d) intervention dose, e) health literacy, and f) cultural group. We will follow an intention-to-treat randomized design using a waitlist control with 450 African-American, Latino, and Vietnamese patients with hypertension and low (<80%) medication adherence. Data collection via pill count, self-report, the electronic health record, and clinical measures will assess medication adherence, BP and other factors at baseline (pre-intervention) and at 4, 10, and 24 weeks post-intervention. IMPaCT is an innovative coordinated care team intervention to improve medication adherence and blood pressure derived from research findings that builds on existing clinical practice. Designed with an eye towards sustainability, IMPaCT incorporates billable pharmacist and CHW services for patients with low medication adherence and high burdens of chronic illness and preventable consequences. IMPaCT offers interprofessional team care with comprehensive expertise and complementary skill sets that mitigate the silo effect of specialized medicine to deliver primary care to diverse, high-risk populations experiencing disparities in hypertension.

抽象的美国面临着高血压的严重种族和种族差异，这会因差异而加剧药物依从性。然而，很少对现有的药物依从性干预量来解决特定不同人群的文化信仰，他们也面临着与之相关的重大结构性障碍贫困，获得护理和粮食不安全。拟议的改善药剂师的药物依从性和CHW团队（影响）干预措施应对针对依从性干预措施的呼吁做出回应少数族裔种族群体的特定需求。影响是基于实践的随机对照试验（RCT）测试对高风险的全面，单独和文化范围的干预措施的有效性高血压，多药和依从性低的患者。影响利用了临床药剂师与社区卫生工作者（CHW）一起担任文化经纪人和患者导航员以遵守个人，临床，社会文化和结构性障碍来解决依从性。这全面，量身定制的协调护理干预旨在改善药物依从性和非裔美国人，拉丁裔和越南移民患者的高血压结局。提议基于实践的RCT旨在满足以下特定目标：目标1：实施影响，是药剂师和 CHW团队。 AIM 2：通过评估干预后确定影响的短期和长期有效性更改：a）药物依从性（近端结局）和血压（BP，远端结果）和B）使用随机对照试验的其他合并健康结果（例如HBA1C，BMI）。目标3：确定与影响有效性相关的因素，包括：a）量身定制干预功能，b）药物信念，c）遵守障碍，d）干预剂量，e）健康素养和f）文化群体。我们将使用450名非裔美国人的候补控制列表控制遵循意向性的随机设计，拉丁裔和越南患者患有高血压和低（<80％）的药物依从性。通过药丸计数，自我报告，电子健康记录和临床措施将评估药物依从性，bp 以及基线（干预前）以及干预后4、10和24周时的其他因素。影响是一个创新协调的护理团队干预措施，以提高药物依从性和血压从基于现有临床实践的研究发现。设计着眼于可持续性 Impact为低药物依从性的患者提供了可计费的药剂师和CHW服务慢性病和可预防的后果的高负担。 Impact提供跨专业团队的护理综合专业知识和互补技能集可以减轻专业医学的孤岛效应向高血压差异的多样化的高风险人群提供初级保健。