Improving medication adherence among people with diabetes who are homeless

提高无家可归的糖尿病患者的药物依从性

• 批准号: 10543822
• 负责人: Katherine Diaz Vickery
• 金额: $ 16.24万
• 依托单位: HENNEPIN HEALTHCARE RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-03-28 至 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10543822
• 关键词: Abbreviations; Accident and Emergency department; Acute; Address; Adherence; Adult; Aftercare; Age; American; Appointment; Behavior Therapy; Behavioral; Behavioral trial; Cardiovascular Diseases; Caring; Cessation of life; Chronic; Chronic Disease; Clinic; Clinical; Collaborations; Communities; Complications of Diabetes Mellitus; Counseling; County; Data; Development; Development Plans; Diabetes Mellitus; Diet; Disparity population; Drug Prescriptions; Educational Materials; Environment; Ethnic Origin; Exercise; Focus Groups; Food Access; Foundations; Frequencies; Funding; Future; General Population; Glucose; Glycosylated hemoglobin A; Goals; Grant; Health; Health Care Costs; Health behavior; Healthcare; Healthcare Systems; Homelessness; Hospitalization; Hospitals; Insurance Coverage; Intervention; Interview; Kidney; Leadership; Learning; Link; Manuals; Manuscripts; Measures; Medical Research; Medical center; Memory; Mental disorders; Mentors; Mentorship; Metabolic; Methods; Minnesota; Modeling; Moods; Motivation; Neighborhood Health Center; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Participant; Patient Self-Report; Patient-Focused Outcomes; Patients; Perception; Persons; Pharmaceutical Preparations; Pharmacy facility; Population; Populations at Risk; Positioning Attribute; Prevalence; Printing; Procedures; Protocols documentation; Provider; Psychosocial Assessment and Care; Public Health; Publications; Randomized, Controlled Trials; Reduce health disparities; Refrigeration; Research; Research Personnel; Risk; Shelter facility; Social support; Statistical Methods; Substance Use Disorder; Telephone; Testing; Training; Training Support; Translational Research; Universities; Visit; Vulnerable Populations; Work; Writing; acceptability and feasibility; arm; behavior test; career; career development; clinical translation; collaborative care; comorbidity; cost; design; diabetes management; disparities in morbidity; disparity reduction; evidence base; experience; food insecurity; glycemic control; health care service utilization; health disparity; health record; housing instability; improved; innovation; insurance claims; medication compliance; meetings; member; modifiable behavior; mortality; motivational enhancement therapy; multidisciplinary; novel; peer; pilot test; pilot trial; practice-based research network; preference; premature; professor; psychosocial; public health relevance; racial minority; recruit; response; safety net; skills; standard care; supported housing; theories; therapy design; trend; vascular stress

PROJECT SUMMARY The long-term objective of this project is to reduce the diabetes health disparities of people with type 2 Diabetes who experience Homelessness, herein abbreviated as DH. The study will focus on diabetes medication adherence as a modifiable behavior known to correlate with glycemic control, all-cause mortality, all-cause hospitalization, and health care cost. The aims are to: (1) Develop the initial Diabetes Homeless Medication Support (D-Homes) treatment manual through focus groups with DH (N=30) at various levels of glycemic control (HgA1c<7, 7-9, >9) and interviews with their multi-disciplinary providers (N=12), (2) Test patient perceptions of the feasibility and acceptability of study procedures and refine the D-Homes treatment manual through test cases (n=10), and (3) Conduct a pilot randomized control trial (N=54) to compare the effect of D-Homes (weekly phone/in-person sessions over 12 weeks) vs. enhanced standard care (identify/reinforce care team, printed educational materials) on medication adherence, glycemic control, and health care utilization. These aims follow a sequential exploratory mixed methods approach. Qualitative focus groups and interviews will gather data about the values, preferences, and barriers to medication adherence faced by DH and their response to proposed intervention components. The initial protocol will be developed using existing evidence-based models and interventions to improve medication adherence, specifically the Information Motivation Behavioral Skills and Collaborative Care Models and use of motivational interviewing as a counseling style. It will also include explicit support for housing, food access, and other psychosocial needs. We will further tailor our protocol by conducting ten test cases. A final protocol will be developed by integrating qualitative and quantitative findings from Aims 1 and 2 with input from a multi-stakeholder panel with providers and community members with lived experience of these issues and the mentorship team. This project will prepare Dr. Vickery for a career as an independent investigator focused on overcoming diabetes and other health disparities among historically disadvantaged groups. Her career development plan includes training goals to: (i) develop tailored, theory-based behavioral interventions to address the needs of vulnerable groups using mixed methods data, (ii) learn to conduct rigorous behavioral trials and statistical methods for analyzing results, (iii) learn to develop and use measures of patient-centered outcomes and medication adherence, (iv) advanced manuscript and grant-writing skills. The research will be conducted in an ideal environment, Hennepin County Medical Center, the largest safety net health care system in the region, and its research arm, the Minneapolis Medical Research Foundation. It will be further strengthened by Dr. Vickery’s appointment as an Assistant Professor at University of Minnesota, a large academic health center with a Clinical Translational Sciences Institute. The interviews and trial will be conducted at shelters in close collaboration with Hennepin County Health Care for the Homeless clinics where Dr. Vickery works clinically.

项目摘要 该项目的长期目标是减少2型患者的糖尿病健康分布 经历无家可归的糖尿病，在这里缩写为DH。该研究将重点放在糖尿病上 药物依从性是一种已知与血糖控制，全因死亡率相关的可修改行为 全因住院和医疗保健费用。目的是：（1）发展初始糖尿病无家可归 通过DH（n = 30）的焦点组在不同级别 血糖控制（HGA1C <7，7-9，> 9）和对其多学科提供者的访谈（n = 12），（2）测试 患者对研究程序的可行性和可接受性的看法并完善了D-Homes治疗 通过测试用例手册（n = 10），（3）进行试验随机对照试验（n = 54）以比较 D-HOMES（每周电话/面对面会议超过12周）的影响与增强的标准护理 （确定/加强护理团队，印刷教育材料）有关药物依从性，血糖控制和 医疗保健利用。这些目的遵循顺序探索性混合方法方法。定性重点 小组和访谈将收集有关药物依从性的价值，偏好和障碍的数据 面对DH及其对拟议干预组件的反应。初始协议将开发 使用现有的基于证据的模型和干预措施来改善药物依从性，特别是 信息动机行为技能和协作护理模型，并使用动机访谈 咨询风格。它还将包括对住房，食物获取和其他社会心理需求的明确支持。 我们将通过执行十例测试案例来进一步量身定制协议。最终协议将通过集成来制定 AIM 1和2的定性和定量发现，由提供商的多方利益相关者小组的投入 以及具有实时经验的社区成员和Mentalship团队。这个项目将 Vickery博士作为一名专注于克服糖尿病和其他的独立调查员的职业生涯 历史上处于弱势群体之间的健康差异。她的职业发展计划包括培训 目标：（i）开发的基于理论的行为干预措施，以满足弱势群体的需求 使用混合方法数据，（ii）学会进行严格的行为试验和统计方法进行分析 结果，（iii）学会开发和使用以患者为中心的结果和药物依从性的度量，（iv） 高级手稿和赠款技巧。该研究将在理想的环境中进行 亨内平县医疗中心，该地区最大的安全净医疗保健系统及其研究部门， 明尼阿波利斯医学研究基金会。 Vickery博士的任命将进一步加强 明尼苏达大学的助理教授，一个大型学术健康中心，拥有临床翻译 科学研究所。访谈和审判将在避难所与亨内平密切合作进行 Vickery博士在临床上工作的无家可归诊所的县卫生保健。