AN EXPERT SYSTEM FOR ADHERENCE TO LIPID LOWERING DRUGS

临床试验确凿地表明，降低胆固醇对冠心病患者有很大好处，显著降低心肌梗死的风险。而有效的药物治疗(如：据估计，至少有60%的患者在一年内停止使用降脂药物。药物不依从是一个长期存在的难以捉摸的现象，它增加了药物的利用率和医疗保健费用，并对健康结果产生了不利影响。现有的研究表明，需要一个理论框架来指导有效干预措施的发展和传播。跨理论行为改变模型（Transtheoretical Model of Behavior Change， TTM）在依从性研究中的应用表明，该模型在这一领域具有很强的解释力。这项快速通道研究计划涉及基于TTM的阶段匹配、个性化和互动干预的开发和临床试验，以主动向整个降脂药物使用者提供依从性。基于计算机的专家系统干预与阶段匹配的自助手册相结合，可能比任何现有的方案都更有效，以更低的成本提供更多的可用性。使用TTM来指导干预措施的发展将提供该领域专家指出的必要的理论性、个体化和互动性框架。建议的商业应用：不坚持使用降脂药物对医疗保健系统中的所有参与者来说都是昂贵的。超过2100万患有血脂异常的成年人有资格接受药物干预。服用这些药物的人中至少有60%没有坚持下去。不坚持使用降脂药物会增加冠心病的发病率和死亡率，以及医疗保健利用率。它还使制药业损失了超过60亿美元的收入。专家系统可以在人群基础上增加对降脂药物的依从性，并且具有成本效益，具有巨大的商业潜力。

Clinical trials have conclusively demonstrated that lowering cholesterol results in large benefits for individuals with coronary heart disease, dramatically reducing the risk of myocardial infarction. While effective pharmacotherapies (i .e., lipid-lowering medications) are available, an estimated minimum of 60% of patients discontinue lipid-lowering medications within one year. Nonadherence to medications is a long- standing, elusive phenomenon that increases utilization and health care costs as well as adversely affecting health outcomes. Existing research demonstrates that a theoretical framework is needed to guide the development and dissemination of effective interventions. Research on the application of the Transtheoretical Model of Behavior Change (TTM) to adherence suggests that the model has strong explanatory power in this area. This Fast-Track research proposal involves the development and clinical trial of TTM based stage-matched, individualized, and interactive interventions for adherence delivered proactively to entire populations of lipid-lowering medication users. Computer based expert system interventions used in conjunction with stage matched self-help manuals have the potential to be more effective than any existing program, offering far greater availability at a low cost. Using the TTM to guide intervention development will provide the theoretical, individualized, and interactive framework that experts in the area have indicated is necessary. PROPOSED COMMERCIAL APPLICATIONS: Nonadherence to lipid-lowering medications is costly to all participants in the health care deliver system. Over 21 million adults with dyslipidemia are eligible for pharmacological intervention. A minimum of 60 % of individuals taking these medications fail to adhere. Nonadherence to lipid-lowering medications increases CHD morbidity and mortality, as well as healthcare utilization. It also costs the pharmaceutical industry over $6 billion in lost revenue. Expert systems that can increase adherence to lipid-lowering medications on a population basis and are cost effective have tremendous commercial potential.