Clinic-based Intervention to Improve Medication Adherence to Reduce CVD Risks

说明(申请人提供)：心血管疾病(CVD)是美国主要的死亡和残疾原因。来自随机试验的证据表明，当治疗高血压和血脂紊乱的药物按标准剂量使用时，它们具有显著的风险降低效果。然而，血脂管理和降压药物的依从性问题是众所周知的。2002年，国家心、肺和血液研究所的成人高胆固醇检测、评估和治疗专家小组(ATPIII)报告说，依从性差的情况在种族和年龄组、社会经济阶层、急性和慢性病以及治疗方案之间存在差异。不遵守或部分坚持的后果在所有类型的临床环境中都可以观察到。ATPIII还报告说，没有一个原因导致服药依从性差。因为没有单一的原因，所以不太可能有一种方法来提高所有人的依从性。这一第二阶段应用的目标是继续开发和进行这一实用且易于交付的干预系统的有效性测试，以帮助患有血脂紊乱和高血压的患者利用几种改善药物依从性的策略。这项干预措施将在常规门诊期间利用一个基于计算机的软件程序：(1)评估患者独特的服药依从性挑战；(2)向患者提供有关遵守其医生开出的药物的量身定制的信息；(3)根据患者的服药依从性评估为患者的医生提供建议。还有其他几种方法可以提高服药依从性。然而，这个拟议的系统提供了独特的功能。它利用非常低成本的技术来指导患者采取符合他或她独特需求的依从性增强策略。患者评估恰好在看医生之前进行，因此医生在处理与药物相关的讨论时的效率可以提高。该系统应该增加医生解决关键依从性问题的一致性。此外，医生对病人的影响可能会受到影响。由于这种干预方法依赖于医生对患者目前的生理特征、最近的处方药以及对患者在就诊时可能经历的副作用的了解，因此该系统应该比一些竞争系统具有质量优势。在第二阶段，我们将根据第一阶段的结果对该系统进行改进，并进行一项前瞻性疗效试验，通过对154名患者和154名在内科、心脏病和社区卫生中心临床机构接受治疗的患者及其医生(N=16)的常规护理，测试该系统改善用药依从性的能力。公共卫生相关性：在美国，心脏病是导致死亡和残疾的主要原因。大多数人在服用处方药方面存在问题。如果拟议的系统被证明在帮助人们服用降压和降胆固醇药物方面有效，它可以降低医疗成本，并提高有心脏病风险的人的生活质量。

DESCRIPTION (provided by applicant): Cardiovascular disease (CVD) is the leading cause of death and disability in the U.S. Evidence from randomized trials suggests that when medications for hypertension and lipid disorders are used at standard dosages, they have a significant risk-reduction effect. Yet, adherence problems to lipid management and antihypertensive medications are well known. In 2002, the National Heart Lung and Blood Institute's Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III) reported that poor adherence crosses ethnic and age groups, socioeconomic strata, acute and chronic diseases, and treatment regimens. The consequences of absent or partial adherence are observed in all types of clinical settings. The ATP III also reports that there is no one cause of poor medication adherence. Since there is no single cause, there is not likely to be one approach to improve adherence in all persons. The goal of this Phase II application is to continue development and conduct efficacy testing of this practical and easily delivered intervention system to assist patients with lipid disorders and hypertension to take advantage of several strategies for improving adherence to medications. The intervention will utilize a computer-based software program during routine clinic visits to: (1) assess a patient's unique medication adherence challenges; (2) provide him or her with tailored information on adhering to medications prescribed by his or her physician; and (3) provide suggestions for that patient's physician based on the patient's medication adherence assessment. Several other approaches are available to improve medication adherence. Yet, this proposed system offers unique features. It utilizes very-low-cost technology to direct a patient to adherence enhancing strategies that fit his or her unique needs. The patient assessment occurs just prior to seeing the physician so physician efficiency in dealing with medication-related discussions can be improved. The system should increase the consistency with which physicians address key adherence issues. Additionally, the physician's influence with the patient is potentially leveraged. Because this intervention approach relies on the physician's understanding of patients' current physiologic characteristics, most recent prescribed medications, and knowledge of side effects a patient may be experiencing at that visit, this system should have a quality advantage over some competing systems. In Phase II, we will enhance the system based on Phase I results, and conduct a prospective efficacy trial to test the ability of the system to improve medication adherence using an intervention groups with 154 patients and a usual care of 154 patients being treated in internal medicine, cardiology and community health center clinical settings and their physicians (N=16). Public Health Relevance: Heart disease is the leading cause of death and disability in the U.S. Most people have problems taking their prescribed medications. If the proposed system proves to be effective in helping people take blood pressure and cholesterol-lowering medicines, it can reduce the costs of healthcare and improve the quality of life for people who have a risk for heart disease.