Improving Medication Adherence with Telehealthcare Medication Therapy Management to Change Health Outcomes in Adolescents and YoungAdults with Asthma (MATCH)

吸入性皮质类固醇（ICS）是治疗青少年哮喘的高效药物 成人（AYA），但在这个年龄组中，ICS的依从率最多为50%，吸入器技术较差， 占60%。依从性差会导致哮喘急性发作，从而增加医疗费用。 药物治疗管理（MTM）是一种结构化，个性化的方法，以优化健康结果 通过改善药物使用，并通过医疗保险处方药，改善， 2003年《现代化法》;现有600多个方案。典型的MTM咨询通过电话进行， 通常是在社区药房。两种设置都不是哮喘患者的最佳选择， 接触缺乏观察和教授吸入器技术所需的视觉互动， 药房缺乏咨询的隐私。视频远程医疗（VT）的使用越来越多， AYA使用带摄像头的智能手机提供了一个机会，将MTM咨询转移到私人 空间我们建议在14至30岁的AYA患者中进行一项为期12个月的盲法随机试验， 哮喘，同时接受ICS以测试MTM VT干预加电子依从性自我管理（EAM） （使用CareTRx传感器和移动的应用程序）与单独使用EAM测量ICS依从性和哮喘 健康结果和确定成本效益。ICS依从性和沙丁胺醇使用情况将通过以下方式进行真实的跟踪： CareTRx，这是新颖的，将提高依从性数据的准确性和相关性。我们的初步数据 提示VT期间吸入器技术培训效果较好，家庭喜欢方便 的VT。我们的长期目标是开发量身定制的，有效的和可持续的MTM VT干预，以改善 哮喘药物依从性和健康结果。美国肺脏协会气道临床 研究中心将进行试验。佛罗里达大学药物质量管理中心， 全国最大的学术MTM提供商，将进行MTM VT遭遇。UF部门 药物结果和政策将进行成本效益分析。使用现有的MTM基础设施 进行有意义的定制VT哮喘依从性干预增加了扩展到其他MTM的可行性 全国各地的节目。我们假设MTM VT加EAM将改善依从性并延长 与单独EAM相比，至哮喘急性发作的时间。我们的具体目标是：（1）确定独特的主题， AYA将为MTM VT提供量身定制的方法;（2）测试MTM VT改善健康的假设， 随机临床试验中的药物治疗结果;（3）检验MTM VT降低哮喘健康的假设 护理费用。这一创新项目的结果非常重要，因为MTM VT是一种可行的替代方案， 患者和提供者通过电话或社区药房进行互动，并分析成本效益， 这对评估可持续性至关重要。MTM是可以提供药物治疗连续性的既定计划 AYA人口过渡到成年和独立的医疗保健管理。

Inhaled corticosteroids (ICS) are highly effective medications for treatment of asthma in adolescents and young adults (AYA), yet in this age group the adherence rate for ICS at best is 50% and poor inhaler technique is present in 60%. Poor adherence results in asthma exacerbations leading to increased healthcare costs. Medication therapy management (MTM) is a structured, individualized approach to optimize health outcomes through improved medication use and is legislated through the Medicare Prescription Drug, Improvement, and Modernization Act of 2003; over 600 programs exist. Typical MTM consultations occur by telephone, and less often, in a community pharmacy setting. Neither setting is optimal for patients with asthma as telephone encounters lack the visual interaction needed for observing and teaching inhaler technique and most pharmacies lack privacy for the consultation. The increased use of video telehealthcare (VT) and the pervasive use of smart phones with cameras by AYA provide an opportunity to move MTM consultations into a private space. We propose a 12-month masked randomized trial in AYA 14- to 30-years old with poorly controlled asthma while receiving ICS to test a MTM VT intervention plus electronic adherence self-management (EAM) (using CareTRx sensors and mobile application), versus EAM alone to measure ICS adherence and asthma health outcomes and determine cost-benefit. ICS adherence and albuterol use will be tracked in real time using CareTRx, which is novel and will improve the accuracy and relevance of adherence data. Our preliminary data indicate that inhaler technique training can be achieved effectively during VT and families like the convenience of VT. Our long-term goal is to develop a tailored, effective, and sustainable MTM VT intervention to improve asthma medication adherence and health outcomes in AYA. The American Lung Association Airways Clinical Research Centers will conduct the trial. The University of Florida Center for Quality Medication Management, the largest academic MTM provider in the nation, will conduct the MTM VT encounters. The UF Department of Pharmaceutical Outcomes and Policy will conduct the cost-benefit analysis. Use of existing MTM infrastructure to conduct a meaningful tailored VT asthma adherence intervention adds feasibility for expansion to other MTM programs around the country. We hypothesize that MTM VT plus EAM will improve adherence and prolong the time to asthma exacerbations compared to EAM alone. Our Specific Aims are to: (1) identify themes unique to AYA that will inform a tailored approach for MTM VT; (2) test the hypothesis that MTM VT improves health and medication outcomes in a randomized clinical trial; (3) test the hypothesis that MTM VT reduces asthma health care costs. The results of this innovative project are important because MTM VT is a viable alternative to patient and provider interaction by phone or in a community pharmacy and analyzing the cost-benefit is essential to evaluating sustainability. MTM are established programs that can provide continuity of medication care as the AYA population transitions into adulthood and independence for their healthcare management.