eMedonline: Telehealth Medication Management System

描述(由申请人提供)：药物治疗是治疗多种疾病的一种相对便宜和有效的治疗策略。然而，接受慢性疗法的患者的平均依从率在一年后约为50%，并随着时间的推移而下降。大约10%的入院病例与药物问题有关，23%的养老院入院病例与药物问题有关。据估计，药物违规每年给美国医疗体系造成的损失估计为766亿美元。在接受药物治疗的人群中，老年人是一个重要群体。他们收到了所有处方的30%，购买了所有非处方药的40%。2003年，美国估计有3600万65岁或以上的人，占总人口的近13%。无法管理药物是老年人需要额外的、往往更昂贵的护理的主要原因之一。了解不依从性的原因并确定帮助患者遵循他们的方案的方法可能会改善健康结果并降低相关成本。这种方法将促进就地老龄化，并可能推迟进入辅助生活设施的需要。健康决策模型表明，不服从行为是多因素的。通过改变一般和具体的健康信念，加强社会互动因素，并优化管理，可以提高遵从性。在第二阶段，我们建议确定eMedOnline药物管理系统是否改善了正在接受高血压治疗的老年患者的依从性。我们将评估样本患者的服药依从性、感知的社会支持和对健康命运的控制感的影响。我们还将在医疗保健提供者、药剂师和护理人员的样本中评估该系统的可接受性。

DESCRIPTION (provided by applicant): Medication is a relatively inexpensive and efficient therapeutic strategy for treating a number of illnesses. However, the average rate of compliance for patients on chronic therapies is about 50% after one year and declines over time. Approximately 10% of hospital admissions are related to medication issues, and 23% of nursing home admissions are related to medication problems. Medication noncompliance is estimated to cost the US healthcare system an estimated $76.6 billion a year. The elderly represent an important population among those receiving drug therapy. They receive 30% of all prescriptions and buy 40% of all over-the-counter drugs. In 2003, there were an estimated 36 million people age 65 or older in the United States, accounting for almost 13% of the total population. The inability to manage medications is one of the leading reasons why seniors need additional, often more expensive care. Understanding the causes of noncompliance and identifying methods to help patients follow their regimens may improve health outcomes and reduce related costs. Such a methodology would facilitate aging in place and may delay the need for admission to assisted living facilities. The health decision model suggests that noncompliant behavior is multi-factorial. By modifying general and specific health beliefs, enhancing social interaction factors, and optimizing administration, compliance can be improved. In Phase II, we propose to determine whether the eMedonline medication management system improves compliance among elderly patients being treated for hypertension. We will evaluate effects on medication compliance, perceived social support, and feelings of control over health destiny in a sample of patients. We will also evaluate the acceptability of the system in a sample of healthcare providers, pharmacists, and caregivers.