A Family-Focused, Literacy-Sensitive Intervention to Improve Medication Adherence

描述(由申请者提供)：这个以患者为导向的导师研究职业发展奖将增强我的能力，以实现我成为心力衰竭(HF)领域的独立心血管护士研究员的长期职业目标。它将使我能够开发和测试干预措施，以改善心力衰竭患者，特别是健康素养较低的患者的服药依从性和健康结果。心力衰竭是一个严重的公共问题。多达50%的患者在出院后六个月内因心力衰竭加重而再次入院。心力衰竭的自然病史可以通过适当的治疗来改变，但药物依从性是实现这一好处的关键。目前约有50%的心衰患者服药依从性不佳，严重后果包括频繁住院，给个人和社会带来巨大的费用，以及生活质量差。几种干预措施改善了心力衰竭患者的用药依从性，但干预结束后效果降低。因此，需要一种新的方法。我和我的指导团队(Michael Pignone博士、Sandra Dunbar博士、Darren DeWalt博士、Carol Golin博士和George Knafl博士)制定了一个全面的培训计划，包括研讨会、短期课程和研讨会，以及一个研究项目，将为我的研究生涯做好准备，重点是改善HF的用药依从性。在K23奖项的拟议项目中，我将试行一种以家庭为重点、对识字敏感的综合干预措施，该干预措施有可能有效地 提高心力衰竭患者的服药依从性，使患者能够持续改善。共有36名服药依从性不佳的心衰患者及其家属将被随机分为干预组或常规护理组。如果这项研究证明了临床实用、护士提供、以家庭为重点和识字敏感的干预措施的可行性和有效性，以改善心力衰竭患者的服药依从性，下一步将开发一种更大规模、更明确的干预测试。改善服药依从性的干预措施可能会降低服药依从性不佳的心衰患者的住院和死亡风险。

DESCRIPTION (provided by applicant): This Mentored Patient-Oriented Research Career Development Award will enhance my ability to achieve my long-term career goal of becoming an independent cardiovascular nurse researcher in the area of heart failure (HF). It will allow me to develop and test interventions to improve medication adherence and health outcomes in patients with HF, especially patients with low health literacy. Heart failure is a serious public problem. Up to 50% of patients are readmitted within six months of discharge for HF exacerbations. The natural history of HF can be modified by appropriate therapy but medication adherence is essential to realize this benefit. About 50% of HF patients now have sub-optimal medication adherence with serious consequences including frequent hospitalizations, enormous expense to individuals and society, and poor quality of life. Several interventions have led to improved medication adherence in patients with HF, but, their effects decreased after completion of the intervention. Thus, there is a need for a new approach. My mentoring team (Drs. Michael Pignone, Sandra Dunbar, Darren DeWalt, Carol Golin, and George Knafl) and I have formulated a comprehensive training program of workshops, short courses, and seminars, and a research project that will prepare me for a research career focusing on improving medication adherence in HF. In the proposed project of the K23 award, I will pilot test an integrated family-focused and literacy-sensitive intervention that has the potential to effectively improve medication adherence in patients with HF and enable patients to sustain the improvement. A total of 36 HF patients with sub-optimal medication adherence and their family members will be randomized to intervention or usual care groups. If the study demonstrates the feasibility and efficacy of a clinically practical, nurse-delivered, family-focused and literacy-sensitive intervention to improve medication adherence in patients with HF, the next step will be to develop a larger, more definitive test of the intervention. Interventions to improve medication adherence may decrease the risk of hospitalization and death among patients with HF who have sub-optimal medication adherence.