Multifaceted Prospective Memory Intervention to Improve Medication Adherence

说明(申请人提供)：坚持用药是预防高血压及其随后的有害和昂贵影响(包括中风、心力衰竭和认知能力下降)的唯一最重要的策略。高血压患者的依从性是一个严重的问题，据估计，只有50%的人适当地坚持他们的处方药。高血压也是一种无症状的慢性疾病，因此没有服用药物的内部记忆线索。高血压在老年人中很普遍，他们被证明经历了认知过程的下降，否则可能会弥补缺乏支持坚持的内部线索。这项拟议的研究的目的是测试家庭内、量身定做的、多方面的前瞻性记忆干预对65岁及以上的成年人坚持服用降压药的影响。这种干预是基于前瞻记忆领域最近的经验和理论发展，并侧重于通过使用保存相对完好的线索驱动和自动过程来提高药物依从性。自我管理至少一种抗高血压药物，并且在4周基线监测后依从性低于或等于90%的老年人将被随机分配到两组中的一组。其中一组将接受由4个阶段组成的干预：建立关系、教育、实施多方面的策略以改善预期记忆和每周强化会议，为期3周。教育对照组将只接受第一和第二阶段干预的一部分，建立关系和教育，并将额外访问3周，与干预组的访问类似，但不会接受策略培训。依从性将使用药物电子监测来确定。假设干预组的总体依从性更强，总体依从性与执行功能/工作记忆之间的关系将小于教育对照组，因为干预减少了实现依从性所需的高水平执行功能。遵守情况将在六个月内进行评估。这项研究的一个主要公共卫生后果是限制老年人的残疾，因为高血压与认知能力下降和包括中风在内的心脑血管疾病有关。虽然这种干预措施正在老年人中进行测试，但这种干预措施对提高其他人群的依从性具有广泛的影响。与公共健康相关：按处方服药是预防高血压影响的唯一最重要的方法。这项研究通过测试一种帮助人们按处方服药的干预措施来解决高血压这一重要的公共健康问题。如果我们能够改善人们服用降压药的方式，我们就可以提高老年人的生活质量，降低医疗保健成本。

DESCRIPTION (provided by applicant): Adherence to medication is the single most important strategy to prevent high blood pressure and its subsequent deleterious and costly effects including stroke, heart failure and cognitive decline. Adherence is a significant problem in hypertension with estimates of only 50 percent appropriately adhering to their prescribed medications. Hypertension is also an asymptomatic chronic illness and therefore one without internal memory cues to medication taking. Hypertension is prevalent among older adults who have been shown to experience declines in cognitive processes that otherwise might compensate for the lack of internal cues to support adherence. The purpose of the proposed study is to test the effect of an in-home, tailored, multifaceted prospective memory intervention on adherence to antihypertensive medication for adults 65 years of age and older. The intervention is grounded in recent empirical and theoretical developments in the area of prospective memory and focuses on enhancing medication adherence through the use of relatively well-preserved cue- driven and automatic processes. Older adults who are self-managing at least one antihypertensive agent and are adherent to this medication less than or equal to 90 percent following 4 weeks of baseline monitoring, will be randomly assigned to one of two groups. One group will receive the intervention consisting of 4 phases: establishing a relationship, education, implementation of multifaceted strategies to improve prospective remembering and weekly reinforcement sessions for 3 weeks. The education comparison group will only receive part of the first and second phase of the intervention, establishing a relationship and education and will be visited for an additional 3 weeks similar to the visits for the intervention group, but will not receive strategy training. Adherence will be determined using Medication Electronic Monitoring. It is hypothesized that the intervention group will have greater overall adherence and that the relationship between overall adherence and executive function/working memory will be smaller than for the education comparison group because the intervention reduces the need for high levels of executive function to achieve adherence. Patterns of adherence will be assessed across a six-month period. A major public health consequence of this study is limiting disabilities among older adults because hypertension is associated with cognitive decline and cardiovascular and cerebrovascular disease including stroke. While this intervention is being tested with older adults, the intervention has broad implications for improving adherence in other populations. PUBLIC HEALTH RELEVANCE: Taking medications as prescribed is the single most important way to prevent the effects of high blood pressure. This study addresses the important public health problem of high blood pressure by testing an intervention to help people take medications as prescribed. If we can improve the way people take blood pressure medicines, we can improve the quality of life for older adults and decrease health care costs.