TeleHealth & Remote Measurement Technologies to Improve Med Adherence in HTN

描述（由申请人提供）：广泛的挑战领域：01：行为，行为改变和预防。具体挑战题目：06-OD(OBSSR)-101。使用新技术来改善或衡量依从性。至少有一半的美国美国的高血压（HTN）患者没有坚持服用处方的抗高血压药物，这导致了一个令人震惊的统计数据，即只有34%的HTN患者的血压得到了控制。尽管如此，在医疗实践环境中几乎没有做什么来提高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。我们的干预对改善依从性和血压控制是有效的，但其效果相对较小（效应值= 0.27）。在这个RC1项目中，我们将探索两项重要的基于技术的修改，旨在提高效果（使用电子测量技术和电子卫生系统通信渠道），以大幅提高我们的远程医疗计划的效果。除了潜在地加强我们的干预，结果将被转移到其他依从性促进项目，并应该推进依从性促进科学。我们计划进行一系列的3项研究，其中前2项的结果将为第三项的设计提供信息。在研究1中，我们将评估测量药物依从性的替代方法和协议，并通过我们的远程医疗计划使用结果来提高依从性。在研究2中，我们将评估通过电子病历向医生提供信息和建议/决策支持的替代策略，以便他们在就诊期间使用，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2的最佳方法和策略，并将它们与我们原来的远程医疗计划相结合。我们将在152例非依从性高血压患者的随机对照试验中评估这一增强方案。我们将确定本研究的效应大小，并将其与我们的原始研究和其他依从性促进计划进行比较，以判断其相对疗效。我们将寻找预期的行为中介效应和已知调节因子对干预效应的影响。该项目的潜在结果是：(1)更有效的干预；(2)更有效的策略使医生参与依从性促进和药物方案调整；(3)了解如何使用3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，只有三分之一接受治疗的高血压患者的血压得到了适当的控制。我们建议利用新技术——1)病人服药和血压的电子监测，2)以计算机为基础的电信技术，以促进病人/医生的沟通，以及3)电子健康记录系统——来帮助病人和他们的医生处理这个问题。在这个项目中，我们将制定一个模型药物改善方案，并将该方案应用于最常见的慢性疾病高血压患者中进行研究。

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.