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

项目总结 心血管疾病(CVD)并发症是糖尿病(DM)相关发病率的主要原因 和死亡率，给公共卫生系统造成了巨大的负担。造成这种负担的部分原因是穷人 服药依从性，21%-42%的患者未能正确坚持他们的护理。重要的是，这个问题是 尤其是在少数民族和低收入人群中，他们表现出较高的慢性病发病率 并降低服药依从性。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合作在改善健康结果方面显示出希望。然而，他们并没有被 广泛实施，部分原因是缺乏令人信服的证据证明其在真正的初级保健中的有效性 设置。项目目标：我们建议评估我们的患者激活计划的影响：Office 实践指南(Office-GAP)与手机短信强化相结合 (Care4life)与手机短信相比，少数民族和低收入糖尿病患者的服药依从性 独自一人。Office-GAP包含共享决策和决策/支持核对表，将在 办公室访问，以促进患者对自己护理的投资。Care4life是一款手机短信服务， 告知并鼓励患者坚持目标，改善沟通。 我们的长期目标是开发一种模式，能够可靠地改善和维持遵守，并可以 在初级保健诊所成功实施，以缩小以下方面的发病率和死亡率差距 少数民族/低收入糖尿病患者。我们假设，面对面的患者激活和 移动电话提供的加固方法将促进患者和护理人员之间的沟通 供应商，提高沟通的频率、准确性和及时性，同时加强共同目标 比起只发手机短信，还能产生更多相互尊重。改善两国之间的通信 患者和医生可以改善服药依从性、血糖、胆固醇、血压 控制，患者对提供者的满意度，并最终减轻疾病负担。 研究策略：我们将在联邦合格健康中心进行一项基于社区的随机临床试验 密歇根州的诊所(FQHC)。我们将在为低收入和少数族裔服务的诊所招收16个小组的378名患者 病人。所有患者都将接受预防糖尿病和心血管疾病的常规护理和药物治疗。八支队伍将参加 随机选择只使用手机短信，8个团队将结合Office-Gap和Care4life。我们 将评估这些共同决策战略对诊所患者和提供者的影响。 影响：如果成功地转化为临床实践，这些干预措施可能会产生重大影响 FQHC的患者护理，改善糖尿病和心血管疾病的预后。这项研究也为转移 一系列慢性疾病的临床实践，在这些疾病中，用药不依从性是一个问题。

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.