AN EXPERT SYSTEM TO IMPROVE MEDICATION ADHERENCE

尽管药物治疗高血压取得了进展，但高达75%的高血压患者的血压控制不佳。未控制的高血压与发病率和死亡率增加相关，主要归因于未能坚持使用抗高血压药物。不遵守药物治疗方案是一个长期存在的现象，增加了医疗保健的利用和成本。现有的研究表明，需要一个理论框架来提高我们设计有效干预措施的能力。初步研究的跨理论模型（TTM）的药物依从性的应用表明，该模型在这方面具有很强的解释力，并有可能指导干预措施的发展。该快速通道建议的第一阶段涉及基于TTM的阶段匹配的、个性化的、交互式干预的开发和可行性测试。可行性包括主动招募70%的合格参与者（n=300）参加一项依从性专家系统干预的随机试验，并评估干预材料的可接受性。计算机化的专家系统干预措施和主动向全体人群提供的阶段匹配手册可以对依从性产生前所未有的影响，以低成本提供更大的可用性。将TTM应用于干预发展将提供该领域专家所指出的必要的理论和个性化框架。拟议的商业应用：在5000万患有高血压的美国人中，高达75%（3750万）未能坚持他们的药物治疗方案。抗高血压药物的不依从性增加了门诊、住院和急诊服务的利用率，在药物相关的发病率和死亡率中占很大比例，每年的费用超过760亿美元。有效且具有成本效益的基于人群的依从性专家系统可以降低发病率、死亡率、卫生保健利用率和相关成本，从而产生巨大的商业潜力。

Despite advances in pharrnacotherapy for hypertension, as many as 75% of hypertensive patients' blood pressure is poorly controlled. Uncontrolled hypertension is associated with increased morbidity and mortality and is largely attributed to failure to adhere with antihypertensive medications. Nonadherence to medication regimens is a long-standing phenomenon that increases health care utilization and costs. Existing research demonstrates that a theoretical framework is needed to advance our ability to design effective interventions. Preliminary research on the application of the Transtheoretical Model (TTM) to medication adherence suggests that the model has strong explanatory power in this area and has the potential to guide intervention development. Phase l of this Fast-Track proposal involves the development and feasibility test of a stage-matched, individualized, interactive intervention based on the TTM. Feasibility includes proactively recruiting 70% of eligible participants (n=300) to participate in a randomized trial of an adherence expert system intervention and evaluating acceptability of the intervention materials. Computerized expert system interventions and stage-matched manuals delivered proactively to entire populations can have unprecedented impacts on adherence, offering far greater availability at a low cost. Applying the TTM to intervention development will provide the theoretical and individualized framework that experts in the area have indicated is necessary. PROPOSED COMMERCIAL APPLICATIONS: Up to 75% (37.5 million) of the 50 million Americans afflicted with hypertension fail to adhere to their medication regimen. Nonadherence with antihypertensives, which increases utilization of outpatient, inpatient, and emergency services, contributes a large proportion of drug-related morbidity and mortality the annual costs of which exceed $76 billion. Effective and cost-effective population-based adherence expert systems can reduce morbidity, mortality, health care utilization, and related costs, resulting in tremendous commercial potential.