IMPROVING MEDICATION ADHERENCE IN COMORBID CONDITIONS

提高合并症条件下的药物依从性

• 批准号: 6647702
• 负责人: JACQUELINE M DUNBAR-JACOB
• 金额: $ 51.76万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2000
• 资助国家: 美国
• 起止时间: 2000-09-29 至 2005-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6647702
• 关键词: behavioral /social science research tag; clinical research; cognition; comorbidity; cost effectiveness; functional ability; human subject; hyperlipidemia; hypertension; noninsulin dependent diabetes mellitus; nursing intervention; problem solving; quality of life; social psychology; social support network; socioeconomics; telecommunications; therapy compliance

DESCRIPTION (investigator's abstract): Improving Medication Adherence in Comorbid Conditions: Approximately 50 percent of persons on prescribed pharmacological therapy have difficulty adhering to their regimen. This difficulty contributes significantly to such adverse outcomes as hospitalization, the development of complications, disease progression, premature disability or death. The costs of poor adherence have been estimated to approach $100 billion dollars a year. Little effort, however, has been directed to the evaluation of adherence intervention strategies and few of those to remedial efforts. A population at particular risk for poor adherence and resulting untoward outcomes are those persons with co-morbid chronic conditions. No efforts have been directed to the remediation of pharmacological adherence problems in this group. It is the aim of this proposed study to evaluate an intervention developed within a problem-solving framework, which has been shown to be effective for a single pharmacological regimen for a single chronic disorder, within a sample on multiple pharmacological therapies for co-morbid conditions. The model for co-morbidity with multiple therapies that we have chosen is Type 2 diabetes with concurrent hypertension and hyperlipidemia. This is a prevalent co-morbid condition with high risk for multiple adverse clinical outcomes. Using a randomized, controlled design, we propose to examine the impact of a telephone delivered counseling intervention among 198 poor adherers who are being treated with oral medications for each of these disorders. Subjects receiving adherence counseling will be further randomized into a maintenance arm and an observation arm for an additional six months. All subjects will have adherence and clinical outcomes assessed at baseline (t1), the end of the 6-month intervention (t2), and again after the six-month follow-up period (t3). Potential predictors of adherence and responsiveness to intervention will be examined, including such factors as cognitive and physical function, quality of life, social support, and perceived problem solving ability, and sociodemographic as well as psychosocial factors. Secondarily, we propose to explore the cost-effectiveness of improving adherence with this intervention. A sample of approximately 198 good adherers, identified during screening, will also be invited to continue adherence monitoring for a 12 month period of time to identify the stability of good adherence levels as well as to identify factors that influence that stability.

描述（研究者的摘要）：改善药物依从性 合并条件：大约50％的处方者 药理疗法很难粘附于其方案。这 困难对不利结果产生了重大贡献 住院，并发症的发展，疾病进展， 早产或死亡。据估计，依从性不佳的成本 每年要接近1000亿美元。但是，很少的努力已经 针对依从性干预策略的评估，很少 这些努力。依从性差的人口特别风险 由此产生的不良结果是那些有慢性慢性的人 状况。没有针对药理学的修复做出的努力 该组的依从性问题。这是这项拟议的研究的目的 评估在解决问题的框架内开发的干预措施 已被证明对单个药理方案有效 单个慢性疾病，在多种药理疗法的样本中 对于合并条件。与多种疗法共同多人的模型 我们选择的是2型糖尿病，并发高血压和 高脂血症。这是一个普遍的合并症，具有高风险 多个不良临床结果。使用随机，受控的设计，我们 建议检查电话交付的咨询干预的影响 在198个贫穷的信徒中，他们正在接受口服药物治疗 这些疾病。接受依从性咨询的受试者将进一步 随机分为维护臂和一个观察臂，再加上六个 月份。所有受试者将在 基线（T1），6个月干预（T2）的末尾，然后在 六个月的随访期（T3）。潜在的依从性预测指标和 将检查对干预的反应，包括 认知和身体功能，生活质量，社会支持和感知 解决问题的能力，社会人口统计学以及社会心理因素。 其次，我们建议探索改善的成本效益 遵守这种干预措施。大约198个好客的样本， 在筛选期间确定，还将邀请继续遵守 监视12个月的时间以确定良好的稳定性 依从性水平以及确定影响稳定性的因素。