TeleHealth & Remote Measurement Technologies to Improve Med Adherence in HTN

远程医疗

• 批准号: 7937086
• 负责人: ROBERT H FRIEDMAN
• 金额: $ 49.95万
• 依托单位: BOSTON MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-30 至 2013-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7937086
• 关键词: Access to Information; Adherence; American; Antihypertensive Agents; Area; Behavior; Behavioral; Blood Pressure; Blood Pressure Monitors; Caring; Chronic Disease; Communication; Computers; Counseling; Data; Development; Disease Management; Economics; Electronic Health Record; Electronics; Equipment; Event; Health; Health system; Home environment; Hypertension; Intervention; Measurement; Measures; Mediating; Medical; Methods; Modeling; Modification; Monitor; Office Visits; Outcome; Patient Care; Patient Monitoring; Patient Noncompliance; Patient Self-Report; Patients; Perception; Pharmaceutical Preparations; Physicians; Prevention; Protocols documentation; Public Health; Randomized Clinical Trials; Recovery; Regimen; Relative (related person); Research; Research Project Grants; Science; Self Care; Series; Source; Surveys; System; Technology; Telecommunications; Testing; Time; arm; base; blood pressure regulation; compliance behavior; design; effective intervention; evidence base; improved; intervention effect; intervention program; medication compliance; new technology; programs; statistics; successful intervention; telehealth; theories; treatment as usual; trial comparing

DESCRIPTION (provided by applicant): Broad Challenge Area: 01: Behavior, Behavioral Change, and Prevention. Specific Challenge Topic: 06-OD(OBSSR)-101. Using new technologies to improve or measure adherence. At least half of the U.S.'s hypertension (HTN) patients are non- adherent to their prescribed anti-hypertensive medications which contributes to the appalling statistic that only 34% of Americans treated for HTN have controlled blood pressure (BP). Nonetheless, there is little being done in medical practice settings to improve adherence in HTN. We pioneered the use of telehealth technology in adherence promotion in medical practice settings. Our intervention was efficacious for improving adherence and BP control, but its effect was relatively small (effect size=.27). In this RC1 project, we will explore 2 significant technology-based modifications designed to increase the effect (using electronic measurement technology and electronic health system communication channels) to substantially enhance the effect of our telehealth program. In addition to potentially enhancing our intervention, the results will be transferable to other adherence promotion programs and should advance the science of adherence promotion. We plan to conduct a series of 3 studies in which the results or the first 2 will inform the design of the third. In study 1, we will evaluate alternative methods and protocols for measuring medication adherence and using the results to improve adherence via our telehealth program. In study 2, we will evaluate alternative strategies for delivering information and advice/decision support to physicians via their EHR for them to use during office visits to promote adherence and BP control. In study 3, we will combine the best methods and strategies from studies 1 & 2 and combine them with our original telehealth program. We will evaluate this enhanced program in a RCT with 152 non- adherent hypertension patients. We will determine the effect size of this study and compare it to our original study and other adherence promotion programs to judge its relative efficacy. We will look for expected behavioral mediating effects and effects of known moderators on intervention effects. The potential outcomes of this project are: (1) a more effective intervention, (2) more effective strategies to engage physicians in adherence promotion & medication regimen adjustment, and (3) understanding on how to use 3 technologies to promote adherence. Patients frequently do not take their medications as their physicians prescribe them, and this is a major contributor to suboptimal health outcomes for patients; for example, only one-third of hypertension patients under treatment have their blood pressure adequately controlled. We propose to utilize new technologies - 1) electronic monitoring of patient medication-taking and blood pressures, 2) computer-based telecommunications technologies for facilitating patient/physician communications, and 3) electronic health records systems - to help patients and their physicians deal with this problem. In this proposed project, we will develop a model medication improvement program and apply this program and study it in patients with hypertension, the most common chronic disease.

描述(由申请者提供)：广泛的挑战领域：01：行为、行为改变和预防。具体挑战主题：06-OD(OBSSR)-101。使用新技术来提高或衡量遵从性。在美国的S高血压患者中，至少有一半的患者没有遵守他们开出的降压药，这导致了令人震惊的统计数据：在接受治疗的美国高血压患者中，只有34%的人控制了血压。尽管如此，在医疗实践环境中，几乎没有采取什么措施来提高HTN的依从性。我们率先在医疗实践环境中使用远程医疗技术来促进依从性。我们的干预在改善依从性和血压控制方面是有效的，但其效果相对较小(效应大小=0.27)。在这个RC1项目中，我们将探索两个重大的基于技术的修改，旨在提高效果(使用电子测量技术和电子医疗系统通信渠道)，以显著增强我们的远程医疗计划的效果。除了可能加强我们的干预外，结果还将转移到其他依从性促进计划中，并应促进依从性促进的科学研究。我们计划进行一系列的3项研究，其中前2项研究的结果将为第三项研究的设计提供参考。在研究1中，我们将评估衡量药物依从性的替代方法和方案，并使用结果通过我们的远程医疗计划改善依从性。在研究2中，我们将评估通过医生的电子病历向医生提供信息和建议/决策支持的替代策略，供医生在办公室探视时使用，以促进依从性和血压控制。在研究3中，我们将结合研究1和研究2中的最佳方法和策略，并将它们与我们最初的远程保健计划相结合。我们将在152名非依从性高血压患者的随机对照试验中对这一增强计划进行评估。我们将确定这项研究的效果大小，并将其与我们最初的研究和其他坚持促进计划进行比较，以判断其相对效果。我们将寻找预期的行为中介效应以及已知的调节因子对干预效果的影响。该项目的潜在结果是：(1)更有效的干预；(2)更有效的策略，让医生参与依从性促进和用药方案调整；(3)了解如何使用三种技术来促进依从性。患者经常不按照医生的处方服药，这是导致患者健康状况不佳的主要原因；例如，接受治疗的高血压患者中只有三分之一的人血压得到了充分的控制。我们建议利用新技术--1)患者服药和血压的电子监控，2)促进患者/医生交流的基于计算机的电信技术，以及3)电子健康记录系统--来帮助患者和他们的医生处理这一问题。在这个拟议的项目中，我们将开发一个模型药物改进计划，并将该计划应用于高血压患者，并对其进行研究。高血压是最常见的慢性病。