Mobile Health Strategies for Veterans with Coronary Heart Disease

这项拟议的研究试图确定文本消息/消息(TM)或移动设备 与提供给所有退伍军人的教育网站相比，应用程序(APP)可以提高 急性冠状动脉综合征或经皮冠状动脉介入治疗后患者抗血小板治疗的依从性 冠状动脉介入治疗(ACS/PCI)。坚持服用抗血小板药物对预防生命至关重要- 具有威胁性的并发症(如支架血栓形成)；然而，不粘连率从21-57%到12%不等 月份。通过TM或移动应用程序来推广移动技术是一种实用且廉价的推广策略 改变行为，提高服药依从性。这项建议的三个具体目标是：1) 确定TM内容和频率的偏好，以通过Focus促进用药依从性 小组；2)通过以下内容分析确定最以患者为中心的应用程序以促进遵从性 所有可商业化的药物依从性应用程序和以可用性为中心的焦点小组；以及3) 通过随机对照研究比较225名退伍军人在接受急性冠脉综合征/冠状动脉介入治疗后对抗血小板药物的依从性 临床试验。参与者将被随机分为TM组、移动应用组或网站控制组。这个 焦点群体将按手机使用率低/高和性别进行分层。 此外，拟议的工作将为朴博士提供必要的指导和经验 将自己确立为心血管疾病预防和治疗领域的早期职业研究员 移动健康研究。Park医生的主要职业目标是成为一名独立的护士调查员 世卫组织应用新技术进行以患者为中心的行为干预以改善临床结果 以及心脏病患者和退伍军人的生活质量。朴博士已经召集了一位杰出的 具有所需培训领域专业知识的跨学科导师团队。艾琳·柯林斯，博士，注册会计师 将担任初级护士导师；医学博士Mary Wooley将担任退伍军人管理局现场导师；Janet Shim博士将担任定性研究导师。此外，约翰·博斯卡丁博士将主持所有 与研究相关的定量统计分析。顾问包括福冈吉美，RN，博士 (移动健康策略专家)和何敏嘉医生(药物依从性和 心血管疾病)。苏珊·伍兹，医学博士，公共卫生硕士(互联健康患者体验总监， 信息和分析办公室，VHA)将作为合作者，特别是在与我们的 使用“Annie”，新的退伍军人管理局自动化TM计划，目的是帮助患者在 他们的健康。 护理研究计划将为Park医生提供一个难得的机会来获得 必要的指导和经验，为令人信服的 研究人员发起研究提案以评估临床结果(例如，心脏发病率和 死亡率)通过多点全面随机对照试验。通过以下方式确定移动技术的效率 退伍军人设计的促进服药依从性的方案将对退伍军人产生重大影响 健康和公共卫生，特别是患有需要严格用药的慢性病患者 坚持不懈。

The proposed research seeks to determine whether text messages/messaging (TM) or a mobile application (app), compared with an educational website-control provided to all Veterans, can improve adherence to antiplatelet therapy among patients following acute coronary syndrome or percutaneous coronary intervention (ACS/PCI). Adherence to antiplatelet medications is critical to prevent life- threatening complications (i.e., stent thrombosis); yet rates of non-adherence range from 21-57% by 12 months. Mobile technology through TM or mobile apps is a practical and inexpensive strategy to promote behavior change and enhance medication adherence. The three specific aims of this proposal are to: 1) determine preferences for content and frequency of TM to promote medication adherence through focus groups; 2) determine the most patient-centered app to promote adherence through a content analysis of all commercially available apps for medication adherence and focus groups centered on usability; and 3) compare adherence to antiplatelet medications in 225 Veterans post ACS/PCI through a randomized clinical trial. Participants will be randomized to either TM, mobile app, or website-control group. The focus groups will be stratified by low/high mobile phone use and sex. In addition, the proposed work will provide Dr. Park with the mentorship and experience necessary to establish herself as an early career investigator in the fields of cardiovascular disease prevention and mobile health research. Dr. Park's primary career goal is to become an independent nurse investigator who applies novel technology for patient-centered behavioral interventions to improve clinical outcomes and quality of life for cardiac patients and Veterans. Dr. Park has assembled an outstanding interdisciplinary team of mentors with expertise in the required areas of training. Eileen Collins, PhD, RN will serve as Primary Nurse Mentor; Mary Whooley, MD will serve as VA On-Site Mentor; and Janet Shim, PhD will serve as Qualitative Research Mentor. In addition, John Boscardin, PhD will conduct all quantitative statistical analyses related to the study. Consultants include Yoshimi Fukuoka, RN, PhD (expert in mobile health strategies) and Dr. Michael Ho (expert in medication adherence and cardiovascular disease). Susan Woods, MD, MPH (Director of Patient Experience, Connected Health, Office of Information and Analytics, VHA) will serve as a collaborator, particularly in relationship to our use of “Annie,” the new VA automated TM program with a goal to help patients take a more active role in their health. The Nursing Research Initiative will provide Dr. Park with an exceptional opportunity to receive the mentorship and experience necessary to prepare a strong scientific foundation for a compelling Investigator Initiated Research proposal to evaluate clinical outcomes (i.e., cardiac morbidity and mortality) through a multi-site full scale RCT. Determining the efficacy of mobile technology through a Veteran-designed protocol to promote medication adherence will have a significant impact on Veteran health and public health, particularly for individuals with chronic diseases that require strict medication adherence.