Interactive Tele-Pharmacy to Improve Chronic Medication Adherence

描述（由申请人提供）：近一半的患者在治疗开始的一年内不坚持他们的处方治疗。不幸的是，现有干预措施在解决这一问题方面的成功相对有限，这要么是因为干预措施的性质，要么是因为它们对不需要或不会从中受益的患者的广泛应用。通过针对慢性疾病控制不佳或恶化的非依从性患者进行干预，并根据改善依从性的意愿和能力为个体患者量身定制干预措施，未来努力的效果可能会增加。由于最有效的干预措施似乎是多方面的，因此往往是复杂的，因此还需要简单的、可纳入日常实践的多模式干预措施。不以行政索赔数据为基础，但可以从自我报告的依从性或快速获得和常规收集的药房交易记录中得出的依从性措施的验证也是一个优先事项。为此，我们提出了一项基于新型远程药剂师干预的聚类随机对照试验（RCT），以提高对高胆固醇血症、高血压和糖尿病药物的依从性。这个应用程序建立在我们小组多年来对改善药物使用和评估现有现实世界输送系统中的新干预措施的研究基础上。该干预措施将整合电子健康记录（EHR）和药房索赔数据的使用，以确定由大约150名初级保健医生护理的大约3000名成年患者，这些患者在现实世界的初级保健中既没有坚持治疗，也没有达到血糖、血压和胆固醇控制的推荐临床目标

DESCRIPTION (provided by applicant): Nearly half of patients become non-adherent to their prescribed therapies within a year of treatment initiation. Unfortunately, the success of existing interventions to address this problem has been relatively limited, either because of the nature of the intervention or their broad applications to patients who do not require them or will not benefi from them. The efficacy of future efforts is likely to be increased by targeting interventions to non-adherent patients with poor or worsening control of their chronic conditions and tailoring interventions to individual patients based upon the willingness and ability to improve their adherence. Because the most effective interventions appear to be those that are multi-faceted and thus often complex, there is also a need for multimodal interventions that are simple and which can be integrated into routine practice. The validation of adherence measures that are not based upon administrative claims data, but which can be derived from self-reported adherence or rapidly available and routinely collected pharmacy transaction records, is also a priority. To this end, we propose a cluster randomized controlled trial (RCT) of a novel tele-pharmacist based intervention to improve adherence to medications for hypercholesterolemia, hypertension, and diabetes. This application builds on many years of research by our group on improving medication use and evaluating novel interventions in existing real-world delivery systems. The intervention will integrate the use of the electronic health record (EHR) and pharmacy claims data to identify approximately 3,000 adult patients cared for by approximately 150 primary care physicians who are both non-adherent and not achieving recommended clinical targets for glycemic, blood pressure, and cholesterol control in a real-world primary care setting. Following EHR-facilitated referral from the treating primary care physicians, a clinical pharmacist will direct an outreach program using multiple communication technologies including text messaging, secure email, mail, and "video visits" with the intensity of the intervention tailored to the patient's level of "activation". The aims of the study are to: (1) implement and evaluate the ability of a novel tele-pharmacist intervention in a multispeciality group practice to improve adherence and clinically relevant outcomes, (2) assess the cost- effectiveness of the intervention, and (3) validate the ability to use retail pharmacy filling data and self-reported daa to evaluate adherence. Using a rigorous randomized design, we have proposed a feasible and sustainable intervention that links adherence to clinically relevant outcome measures as a core component of the program. As the nation considers substantial investments in health information technology and primary care based population management, our intervention will provide important insights into how to effectively improve medication adherence and ultimately, chronic care outcomes.