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

描述（由申请人提供）：心血管疾病（CVD）是美国死亡和残疾的主要原因，随机试验的证据表明，当高血压和脂质紊乱药物以标准剂量使用时，它们具有显着的风险降低效果。然而，脂质管理和抗高血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检测、评估和治疗成人高血胆固醇专家小组（ATP III）报告说，依从性差跨越了种族和年龄组、社会经济阶层、急性和慢性疾病以及治疗方案。在所有类型的临床环境中都观察到缺乏或部分依从性的后果。ATP III还报告说，没有一个原因导致药物依从性差。由于没有单一的原因，不可能有一种方法来改善所有人的依从性。II期申请的目标是继续开发和进行这种实用且易于交付的干预系统的疗效测试，以帮助患有脂质紊乱和高血压的患者利用几种策略来提高药物依从性。干预将在常规门诊访问中利用基于计算机的软件程序：(1)评估患者独特的药物依从性挑战；(2)为患者提供量身定制的遵医嘱用药信息；(3)根据患者的服药依从性评估，为患者的医师提供建议。还有其他几种方法可以改善药物依从性。然而，这个提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其独特需求的依从性增强策略。病人的评估发生在看医生之前，这样医生处理药物相关讨论的效率就可以提高。该系统应提高医生解决关键依从性问题的一致性。此外，医生对病人的影响是潜在的杠杆作用。由于这种干预方法依赖于医生对患者当前生理特征的理解，最近的处方药物，以及患者在就诊时可能经历的副作用的知识，因此该系统应该比一些竞争系统具有质量优势。在第二阶段，我们将在第一阶段结果的基础上加强该系统，并进行一项前瞻性疗效试验，以测试该系统提高药物依从性的能力，使用干预组154名患者和常规护理组154名在内科、心脏病学和社区卫生中心临床环境中接受治疗的患者及其医生（N=16）。公共卫生相关性：心脏病是美国死亡和残疾的主要原因，大多数人在服用处方药方面存在问题。如果提出的系统被证明在帮助人们服用降压和降胆固醇药物方面是有效的，它可以降低医疗保健成本，提高有心脏病风险的人的生活质量。

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 II application is to continue development and conduct efficacy testing of this 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 routine 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 II, we will enhance the system based on Phase I results, and conduct a prospective efficacy trial to test the ability of the system to improve medication adherence using an intervention groups with 154 patients and a usual care of 154 patients being treated in internal medicine, cardiology and community health center clinical settings and their physicians (N=16). Public Health Relevance: Heart disease is the leading cause of death and disability in the U.S. Most people have problems taking their prescribed medications. If the proposed system proves to be effective in helping people take blood pressure and cholesterol-lowering medicines, it can reduce the costs of healthcare and improve the quality of life for people who have a risk for heart disease.