USING INFORMATION TECHNOLOGY TO IMPROVE ASTHMA ADHERENCE

描述(由申请人提供)：据估计，定期使用吸入性皮质类固醇(ICS)可以减少80%与哮喘相关的住院时间。吸入皮质类固醇可以显著改善肺功能，并防止哮喘恶化和死亡。然而，哮喘患者的ICS使用率仍然很低，衡量ICS依从性的研究表明，患者只在20%到73%的时间里服用处方剂量。总之，这些发现表明，增加对ICS的依从性可能会导致哮喘相关结局的显著改善。不幸的是，很少有行为或教育干预被证明在改善依从性和哮喘控制方面非常有效，尽管在某些情况下在患者身上投入了相当多的时间。鉴于依从性信息对临床决策和疾病管理的重要性，令人惊讶的是，直到最近才有研究关注向医生提供这种信息的影响。然而，即使来自这些小型研究的有限证据也表明，仅仅向临床医生提供依从性信息可以对患者的依从性产生深远的影响。一个挑战是如何在时间和资源往往有限的诊所环境中提供依从性信息。称重罐和电子记录设备已被用来测量ICS的依从性，但这些方法太耗时且昂贵，不能被大多数临床医生使用。也可以使用药房索赔数据来估计服药依从性。由于索赔数据是出于其他原因收集的，因此这些基于药房的遵从性措施的生成成本相对较低，并且可以在大量患者身上使用。这个应用程序寻求开发和测试一种工具，该工具通过电子病历向医生反馈依从性信息。这些遵从性措施将通过将处方数据与药房索赔相关联来生成。这种方法的潜在好处是既易于在临床实践中使用，又具有经济上的可持续性。在一个基准期之后，初级保健医生将被随机接受关于他们的持续性哮喘患者的ICS依从性信息。主要结果将是依从性较基线的变化以及治疗组之间依从性的差异。还将评估与基线相比的变化以及治疗组和对照组在患者-临床医生沟通、患者对坚持治疗的态度、与疾病控制相关的结果以及医疗费用方面的差异。

DESCRIPTION (provided by applicant): It has been estimated that regular use of inhaled corticosteroids (ICS) could reduce asthma-related hospitalization by 80%. Inhaled corticosteroids can significantly improve lung function, as well as prevent asthma exacerbations and death. Yet, ICS use remains low among patients with asthma, and studies measuring ICS adherence suggest that patients take their prescribed dose on only 20% to 73% of days. Together these findings suggest that increase adherence to ICS could result in significant improvements in asthma-related outcomes. Unfortunately, few behavioral or educational interventions have been shown to be very effective at improving adherence and asthma control, despite in some cases considerable time invested with the patient. Given the importance of adherence information to clinical decision making and disease management, it is surprising that not until recently have there been studies looking at the effects of providing this information to physicians. However, even the limited evidence from these small studies suggests that simply providing adherence information to clinicians can have a profound influence on patient adherence. One challenge is how to provide adherence information in the clinic setting where time and resources are often limited. Weighing canisters and electronic recording devices have been used to measure adherence to ICS, but these methods are too time consuming and expensive to be used by most clinicians. Medication adherence can also be estimated using pharmacy claims data. Since claims data are collected for other reasons, these pharmacy-based adherence measures are relatively inexpensive to generate and they are available on a large number of patients. This application seeks to develop and test a tool, which feeds back adherence information to physicians via the electronic medical record. These adherence measures will be generated by linking prescription data to pharmacy claims. This method has the potential benefit of being both easily use in clinical practice and financially sustainable. After a baseline period, primary care physicians will be randomized to receive ICS adherence information on their patients with persistent asthma. The primary outcomes will be the change in adherence from baseline and the difference in adherence between treatment groups. Also assessed will be changes from baseline and differences between the treatment and control groups in patient-clinician communication, patient attitudes toward adherence, outcomes related to disease control, and medical care costs.