Leveraging Patient Portals to Improve Medication Adherence in Type 2 Diabetes

描述(申请人提供)：对于糖尿病患者，降糖剂(GLA)可改善血糖控制(HbA1c)，并防止疾病相关并发症和过早死亡。患者必须遵守处方方案才能获得这些好处，研究表明依从性很差，对口服Glas的依从性从36%到85%不等；然而，较少使用胰岛素的患者报告依从性较差。可以利用现有技术(如手机、互联网提醒、患者门户网站)向糖尿病患者提供服药依从性提醒和支持，进而改善临床结果。本提案描述了一项职业发展计划，该计划将使首席调查员(PI)成为一名能够利用各种技术设计和评估糖尿病自我护理干预措施的独立调查员。该提案描述了一种研究战略，其中PI将使用Vanderbilt的患者门户网站(PWP)来提供基于理论的GLA依从性促进干预。作为一名接受过健康行为改变培训的社会/健康心理学家，PI将通过这项K01获得补充的、开发和使用技术的新技能。PI的直接目标是使用PWP向糖尿病患者提供以信息-动机-行为技能(IMB)为重点的GLA依从性干预。为了实现这一目标，国际和平研究所提出了一项职业发展计划，其中包括先进的教学课程工作、参加地方和国家会议/研讨会/会议、有指导的研究经验以及积极参与极其有利的研究环境。这种环境包括NIDDK资助的糖尿病研究和培训中心(DRTC)、全国知名的生物医学信息学系、最先进的患者PWP、NIH资助的CTSA、卫生服务研究中心(CHSR)和有效健康沟通计划(EHC)。这项研究的具体目标是：(1)对糖尿病患者和提供者进行启发性研究，以确定在糖尿病和药物管理中使用PWP和其他技术的障碍；(2)设计通过现有PWP提供的GLA依从性干预措施，测试糖尿病患者的可用性，并在评估之前改进干预措施；以及(3)进行随机对照试验，以测试干预措施对3个月和6个月的多种依从性和HbA1c的影响。此外，PI将测试干预是否增强了基于IMB模型的依从性行为的关键决定因素，以及IMB元素的变化是否映射到依从性和HbA1c随时间的改善。最后，PI将测试IMB元素对粘附性的影响的潜在调节剂。在拟议的研究中利用技术将增强PI在设计和评估行为改变干预措施方面的现有培训。最重要的是，这将加速她作为一名成功的独立调查员的职业生涯，使她有能力设计和评估尖端的、理论上扎根的干预措施，并广泛应用于糖尿病行为研究和临床护理领域。

DESCRIPTION (provided by applicant): For patients with diabetes, glucose lowering agents (GLA) improve glycemic control (HbA1c), and prevent disease-related complications, and premature death. Patient adherence to prescribed regimens is necessary to reap these benefits, and studies suggest adherence is poor, ranging from 36% to 85% adherence to oral GLAs; however, fewer patients using insulin report poor adherence. Existing technologies (e.g., cell phones, Internet reminders, patient web portals) could be leveraged to provide medication adherence reminders and support to patients with diabetes and, in turn, improve clinical outcomes. This proposal describes a career development plan that will prepare the principal investigator (PI) for success as an independent investigator who can leverage various technologies to design and evaluate diabetes self-care interventions. The proposal describes a research strategy in which the PI will use Vanderbilt's patient web portal (PWP) to deliver a theory-based GLA adherence promotion intervention. As a social/health psychologist with training in health behavior change, the PI will acquire complementary, new skills for developing and using technology through this K01. The PI's immediate goal is to use a PWP to deliver an Information-Motivation-Behavioral skills (IMB) focused GLA adherence intervention to patients with diabetes. To meet this goal, the PI has proposed a career development plan that integrates advanced didactic course work, participation in local and national meetings/seminars/workshops/conferences, a mentored research experience, and active involvement in an extremely supportive research environment. This environment includes an NIDDK funded Diabetes Research and Training Center (DRTC), nationally known Department of Biomedical Informatics, state-of-the-art patient PWP, NIH funded CTSA, Center for Health Services Research (CHSR), and Program on Effective Health Communication (EHC). The research specific aims are to: (1) conduct elicitation research with diabetes patients and providers to identify barriers to using a PWP and other technologies for diabetes and medication management; (2) design a GLA adherence intervention delivered via an existing PWP, test for usability with diabetes patients, and refine the intervention prior to evaluation; and (3) perform a randomized controlled trial to test the effect of the intervention on multiple measures of adherence and HbA1c at 3- and 6-months. In addition, the PI will test whether the intervention enhances critical determinants of adherence behavior based on the IMB model, and whether changes in IMB elements map onto improvements in adherence and HbA1c across time. Lastly, the PI will test potential moderators of the effect of the IMB elements on adherence. Leveraging technology in the proposed research will augment the PI's existing training in the design and evaluation of behavior change interventions. Most importantly, it will accelerate her career as a successful independent investigator well equipped to design and evaluate cutting-edge, theoretically grounded interventions with broad application to both the field of diabetes behavioral research and clinical care.