Clinic-based Intervention to Improve Medication Adherence to Reduce CVD Risks

说明(申请人提供)：心血管疾病(CVD)是美国主要的死亡和残疾原因。来自随机试验的证据表明，当治疗高血压和血脂紊乱的药物按标准剂量使用时，它们具有显著的风险降低效果。然而，血脂管理和降压药物的依从性问题是众所周知的。2002年，国家心、肺和血液研究所的成人高胆固醇检测、评估和治疗专家小组(ATPIII)报告说，依从性差的情况在种族和年龄组、社会经济阶层、急性和慢性病以及治疗方案之间存在差异。不遵守或部分坚持的后果在所有类型的临床环境中都可以观察到。ATPIII还报告说，没有一个原因导致服药依从性差。因为没有单一的原因，所以不太可能有一种方法来提高所有人的依从性。这一第一阶段提案的目标是开发和测试一种实用且易于交付的干预系统，以帮助血脂紊乱和高血压患者利用几种提高药物依从性的策略。该干预措施将在常规护理诊所就诊期间利用一个基于计算机的软件程序来：(1)评估患者独特的服药依从性挑战；(2)向患者提供关于遵守其医生开出的药物的量身定制的信息；以及(3)根据患者的服药依从性评估为患者的医生提供建议。还有其他几种方法可以提高服药依从性。然而，这个拟议的系统提供了独特的功能。它利用非常低成本的技术来指导患者采取符合他或她独特需求的依从性增强策略。患者评估恰好在看医生之前进行，因此医生在处理与药物相关的讨论时的效率可以提高。该系统应该增加医生解决关键依从性问题的一致性。此外，医生对病人的影响可能会受到影响。由于这种干预方法依赖于医生对患者目前的生理特征、最近的处方药以及对患者在就诊时可能经历的副作用的了解，因此该系统应该比一些竞争系统具有质量优势。在第一阶段，我们将开发软件程序，并评估系统的可接受性、可行性和系统提供准确和相关数据以改善用药依从性的能力，使用60名在内科、初级保健和心脏病临床实践中接受治疗的患者志愿者及其医生(N=10)。

DESCRIPTION (provided by applicant): Cardiovascular disease (CVD) is the leading cause of death and disability in the U.S. Evidence from randomized trials suggests that when medications for hypertension and lipid disorders are used at standard dosages, they have a significant risk-reduction effect. Yet, adherence problems to lipid management and antihypertensive medications are well known. In 2002, the National Heart Lung and Blood Institute's Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III) reported that poor adherence crosses ethnic and age groups, socioeconomic strata, acute and chronic diseases, and treatment regimens. The consequences of absent or partial adherence are observed in all types of clinical settings. The ATP III also reports that there is no one cause of poor medication adherence. Since there is no single cause, there is not likely to be one approach to improve adherence in all persons. The goal of this Phase I proposal is to develop and test a practical and easily delivered intervention system to assist patients with lipid disorders and hypertension to take advantage of several strategies for improving adherence to medications. The intervention will utilize a computer-based software program during usual care clinic visits to: (1) assess a patient's unique medication adherence challenges; (2) provide him or her with tailored information on adhering to medications prescribed by his or her physician; and (3) provide suggestions for that patient's physician based on the patient's medication adherence assessment. Several other approaches are available to improve medication adherence. Yet, this proposed system offers unique features. It utilizes very-low-cost technology to direct a patient to adherence enhancing strategies that fit his or her unique needs. The patient assessment occurs just prior to seeing the physician so physician efficiency in dealing with medication-related discussions can be improved. The system should increase the consistency with which physicians address key adherence issues. Additionally, the physician's influence with the patient is potentially leveraged. Because this intervention approach relies on the physician's understanding of patients' current physiologic characteristics, most recent prescribed medications, and knowledge of side effects a patient may be experiencing at that visit, this system should have a quality advantage over some competing systems. In Phase I, we will develop the software program and evaluate system acceptability, feasibility and the ability of the system to provide accurate and relevant data to improve medication adherence using 60 patient volunteers being treated in internal medicine, primary care and cardiology clinical practices and their physicians (N=10).