Improving Diabetic Patients’ Adherence to Treatment and Prevention of Cardiovascular Disease

项目摘要 心血管疾病（CVD）并发症是糖尿病（DM）相关疾病的主要原因 和死亡率，对公共卫生系统造成重大负担。这一负担部分归因于贫穷， 药物依从性，21-42%的患者未能正确坚持他们的护理。重要的是，这个问题 在少数民族和低收入人群中尤其明显，这些人群的慢性病发病率较高 和较低的药物依从性。促进和加强以患者为中心的沟通的干预措施 临床医生和患者之间的沟通显示出改善健康结果的希望。然而，他们没有被 广泛实施，部分原因是缺乏令人信服的证据证明其在真实的初级保健中的有效性 设置.项目目标：我们建议评估患者激活程序的影响：Office 结合移动的电话短信强化的实践应用指南（GAP） （Care 4life）与移动的短信相比，在少数和低收入DM患者中对药物依从性的影响 一个人《性别平等行动计划》纳入了共同决策和一份决策/支助清单， 诊所访问，以促进病人对自己护理的投资。Care 4life是一项手机消息服务， 告知并鼓励患者坚持目标并改善沟通。 我们的长期目标是开发一种能够可靠地提高和维持依从性的模型， 在初级保健诊所成功实施， 少数/低收入DM患者。我们假设，结合面对面的病人激活和 移动的电话传递强化方法将促进患者和护理之间的沟通 供应商，提高沟通的频率，准确性和及时性，同时加强共同的目标 并且比仅仅通过移动的手机短信更能产生相互尊重。之间的改进的通信 患者和医生可以改善药物依从性、血糖、胆固醇、血压 控制和患者对提供者的满意度，并最终减少疾病负担。 研究策略：我们将在联邦卫生部进行一项基于社区的随机临床试验。 密歇根州的诊所（英语：Clinics（Michigan））。我们将在为低收入和少数族裔服务的诊所的16个小组中招募378名患者 患者所有患者将接受常规护理和药物治疗，以预防DM和CVD。八支球队将在 随机选择使用移动的手机短信，8个团队将联合收割机与Care 4life相结合。我们 将评估这些共同决策策略对诊所中患者和提供者的影响。 影响：如果成功地转化为临床实践，这些干预措施有可能产生重大影响。 患者护理，改善糖尿病和心血管疾病的预后。这项研究也为转移铺平了道路 在一系列慢性疾病的临床实践中，药物不依从是一个问题。

PROJECT SUMMARY Cardiovascular disease (CVD) complications are the leading cause of diabetes mellitus (DM)-related morbidity and mortality, creating a significant burden on the public health system. This burden is in part attributable to poor medication adherence, with 21-42% of patients failing to properly adhere to their care. Importantly, this issue is especially pronounced in minority and low-income populations, which show higher rates of chronic illness and lower medication adherence. Interventions that foster and reinforce patient-centered communication between clinicians and patients show promise in improving health outcomes. However, they have not been widely implemented, in part due to a lack of compelling evidence for their effectiveness in real primary care settings. Project Objective: We propose to evaluate the impact of our patient activation program: Office Guidelines Applied to Practice (Office-GAP) combined with mobile phone text messaging reinforcement (Care4life) on medication adherence, in minority and low-income patients with DM compared to mobile texting alone. Office-GAP incorporates shared decision-making and a decision/support checklist to be completed during office visits, to foster patients' investment in their own care. Care4life is a cell phone messaging service that informs and encourages patients to adhere to goals and improve communication. Our long-term goal is to develop a model that can reliably improve and sustain adherence and can be successfully implemented in primary care clinics to close the morbidity and mortality gap for minority/low-income DM patients. We hypothesize that the combined face-to-face patient activation and mobile phone delivered reinforcement methods will facilitate communication between patients and care providers, improving the frequency, accuracy, and timeliness of communication while reinforcing shared goals and engendering mutual respect more than mobile phone texting alone. Improved communication between patients and physicians may improve medication adherence, blood sugar, cholesterol, blood pressure control, and patient satisfaction with providers, and ultimately decrease burden of illness. Research Strategy: We will conduct a randomized community-based clinical trial in Federally-Qualified Health Clinics (FQHCs) in Michigan. We will enroll 378 patients in 16 teams in clinics serving low-income and minority patients. All patients will receive usual care and medication for DM and CVD prevention. Eight teams will be randomly chosen to use mobile phone texting alone, and 8 teams will combine Office-GAP with Care4life. We will evaluate the impact of these shared decision-making strategies for patients and providers in the clinics. Impact: If successfully translated to clinical practice, these interventions have the potential to significantly impact patient care in FQHCs, improving outcomes for DM and CVD. This research also paves the way for shifting clinical practice across a spectrum of chronic disease where medication non-adherence is an issue.