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（由申请人提供）：广泛的挑战领域：01：行为，行为改变和预防。特定挑战主题：06-OD（OBSSR）-101。使用新技术来提高或衡量依从性。至少有一半的美国美国的高血压（HTN）患者不遵守他们的处方抗高血压药物，这导致了令人震惊的统计数据，即只有34%的接受HTN治疗的美国人控制了血压（BP）。尽管如此，在医疗实践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促进依从性。我们的干预措施对于改善依从性和血压控制是有效的，但其效果相对较小（效应量= 0.27）。在这个RC 1项目中，我们将探索2个重要的基于技术的修改，旨在增加效果（使用电子测量技术和电子健康系统通信渠道），以大大提高我们的远程医疗计划的效果。除了可能加强我们的干预，结果将转移到其他坚持促进计划，并应推进坚持促进科学。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方案，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EHR向医生提供信息和建议/决策支持的替代策略，以便他们在办公室访问期间使用，以促进依从性和BP控制。在研究3中，我们将结合联合收割机的最佳方法和策略，从研究1和2和联合收割机他们与我们原来的远程医疗计划。我们将在一项包含152名非依从性高血压患者的随机对照试验中评估这种增强方案。我们将确定本研究的效应量，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，以判断其相对有效性。我们将寻找预期的行为中介效应和已知的调节剂对干预效果的影响。该项目的潜在成果是：（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药物方案调整，以及（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用药物，这是患者健康状况不佳的主要原因;例如，只有三分之一的高血压患者在接受治疗时血压得到充分控制。我们建议利用新技术- 1）电子监测患者服药和血压，2）基于计算机的电信技术，以促进患者/医生的沟通，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个问题。在这个拟议的项目中，我们将开发一个模型药物改善计划，并应用该计划，并在最常见的慢性疾病高血压患者中进行研究。