Phone Calls to Promote Adherence with Inhaled Corticoste

描述（由申请方提供）：在医学文献中，患者未能遵守医生处方的慢性药物治疗方案已得到充分记录。在包括高血压、哮喘和充血性心力衰竭在内的多种慢性疾病中，已经证明了依从性差。这种不依从性的临床影响可能包括治疗失败、不必要和危险的强化治疗、住院和死亡。世界卫生组织最近的一份报告得出结论，治疗不依从性大大有助于疾病发病率，降低生活质量，并增加卫生保健利用。本研究的目的是测试使用语音识别（SR）软件进行电话外展的有效性，以提高一个大型健康维护组织的哮喘或慢性阻塞性肺病（COPD）患者对吸入性皮质类固醇（ICS）的依从性。主要结局将是药物获取的连续测量和药物缺口的连续测量。次要结局指标包括自我评估的药物使用模式、疾病特异性健康状况、护理满意度、哮喘/COPD的医院服务使用情况和哮喘/COPD的急性护理总成本。这项随机临床试验将入组Kaiser Permanente Northwest和夏威夷地区约24，500名18岁或以上的成员，这些成员在随机化前一年内将因哮喘或COPD就诊并接受至少一次呼吸药物分配。受试者将在患者水平上随机接受常规护理或旨在促进改善ICS药物依从性的基于SR的干预。随机化将在最初的14个月开发阶段后进行，在此期间开发，试点和最终确定干预脚本。干预将在随机化后持续一年。相关性：这项研究的目的是测试电话语音识别软件，以改善患者如何服用哮喘和长期肺病药物。这种方法，如果它可以帮助人们按照规定服用药物，可以用于各种其他长期的医疗条件。

DESCRIPTION (provided by applicant): The failure of patients to adhere to physician-prescribed chronic medication regimens has been well- documented in the medical literature. Poor adherence has been demonstrated across a wide range of chronic conditions, including hypertension, asthma, and congestive heart failure. The clinical implications of this non-adherence can include treatment failure, unnecessary and dangerous intensification of therapy, hospitalizations, and deaths. A recent report of the World Health Organization concluded that therapy non- adherence contributes substantially to disease morbidity, reduced quality of life, and increased health care utilization. The objective of this research is to test the effectiveness of conducting telephone outreach using speech recognition (SR) software to improve adherence to inhaled corticosteroids (ICS) among members of a large health maintenance organization with asthma or chronic obstructive pulmonary disease (COPD). The primary outcomes will be the continuous measure of medication acquisition and the continuous measure of medication gaps. Secondary outcome measures include self-assessed patterns of medication use, disease- specific health status, satisfaction with care, use of hospital-based services for asthma/COPD, and total cost of acute care for asthma/COPD. This randomized clinical trial would enroll the estimated 24,500 members of the Kaiser Permanente Northwest and Hawaii regions aged 18 years or older who will have been seen for asthma or COPD and received at least one dispensing of a breathing medication during the year prior to randomization. Participants will be randomized at the patient level to receive either usual care or an SR-based intervention designed to promote improved adherence to ICS medications. Randomization will occur after an initial 14- month development phase during which the intervention scripts are developed, piloted, and finalized. The intervention will continue for one year post randomization. Relevance: The goal of this research is to test speech recognition software for telephone calls to improve how patients take medications for asthma and long-term lung disease. This method, if it helps people take their medications as prescribed, could be used with a variety of other long-term medical conditions.