Interventions for Adherence to Oral Antipsychotic Medications in Schizophrenia

精神分裂症患者坚持口服抗精神病药物的干预措施

• 批准号: 7029972
• 负责人: Dawn Irene Velligan
• 金额: $ 44.54万
• 依托单位: UNIVERSITY OF TEXAS HLTH SCIENCE CENTER
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-08-15 至 2011-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7029972
• 关键词: antipsychotic agents; behavioral /social science research tag; bioengineering /biomedical engineering; clinical research; clinical trials; cognitive behavior therapy; combination therapy; community mental health services; computer assisted medical decision making; computer assisted patient care; cost effectiveness; home health care; hospital utilization; human subject; human therapy evaluation; longitudinal human study; patient monitoring device; patient oriented research; psychiatric patient care; psychological adaptation; satisfaction; schizophrenia; social support network; telemedicine; therapy compliance; antipsychotic agents; behavioral /social science research tag; bioengineering /biomedical engineering; clinical research; clinical trials; cognitive behavior therapy; combination therapy; community mental health services; computer assisted medical decision making; computer assisted patient care; cost effectiveness; home health care; hospital utilization; human subject; human therapy evaluation; longitudinal human study; patient monitoring device; patient oriented research; psychiatric patient care; psychological adaptation; satisfaction; schizophrenia; social support network; telemedicine; therapy compliance

DESCRIPTION (provided by applicant): Poor adherence to antipsychotic medication can lead to relapse, rehospitalization and poor outcomes for schizophrenia patients. We have demonstrated that the use of environmental supports (signs, alarms, organization of belongings) in a program known as Cognitive Adaptation Training (CAT) and its counterpart PharmCAT which focuses only on medication adherence improve adherence and outcomes. PharmCAT involves weekly home visits to establish and maintain environmental supports that bypass cognitive and situational problems and cue the taking of medication as prescribed. Our goal is to develop the most cost effective ways of improving adherence. New technologies such as the Med-eMonitor(tm) a specialized pill container (capable of cueing the taking of medication, warning patients when they are taking the wrong medication or taking it at the wrong time, recording side effect complaints, and through automatic download to a secure website promptly alerting treatment staff of failures to take medication as prescribed) is an electronic analog to what is done in PharmCAT treatment. Using the MM which relies more on technology and less on in-home visits by treatment staff may help to make environmental supports available to a wider range of patients. We will randomly assign 150 patients taking atypical antipsychotics to one of 3 treatment groups for a period of 9 months: 1) PharmCAT, 2) Med-eMonitor (MM) or 3) standard treatment (SO). Primary outcome variables will include compliance to antipsychotic medication, compliance to concomitant medication, and community outcomes. Repeated Measures Analyses of Covariance for mixed models, will be utilized to examine group differences on the outcome variables during treatment with pretreatment scores used as covariates. We hypothesize that both MM which identifies adherence problems almost immediately and PharmCAT which provides a high degree of personal contact will improve adherence and outcomes in comparison to standard treatment. In a preliminary manner, we will compare patient satisfaction and the direct costs of delivering PharmCAT and MM treatment. This study will lead to the refinement of interventions targeting improved adherence in this population. Maximum benefits of effective medication cannot be achieved without appropriate adherence. The public health implications include effective disease management, maximizing long-term outcomes, and containing health care costs for schizophrenia.

描述（由申请人提供）：对抗精神病药物的依从性较差会导致精神分裂症患者的复发，再培养和不良结局。我们已经证明，在一个称为认知适应训练（CAT）的程序中，使用环境支持（标志，警报，财产组织）及其对应药cot仅着重于药物依从性，可以提高依从性和结果。 PharmCat涉及每周的家庭访问，以建立和维持绕过认知和情境问题的环境支持，并提示服用处方药。我们的目标是开发提高依从性的最具成本效益的方式。新技术，例如Med-Med-Med-Mednotor（TM）一个专用的药丸容器（能够提示服用药物，警告患者在服用错误的药物或在错误的时间服用药物，记录副作用投诉，并通过自动下载的副作用，并通过自动下载到一个安全的网站上，迅速将治疗人员提醒治疗人员的药物治疗员工以服用药物，以服药为一种电子模拟治疗。使用更多依赖技术的MM，而治疗人员则更少依靠在家访问，这可能有助于使更广泛的患者提供环境支持。我们将在9个月内随机分配150例服用非典型抗精神病药的患者为3个治疗组之一：1）PharmCat，2）Med-meNter（MM）或3）标准治疗（SO）。主要结果变量将包括遵守抗精神病药物，对伴随药物的依从性以及社区结果。重复测量混合模型的协方差分析，将利用用用作协变量的预处理评分来检查结果变量的群体差异。我们假设两个MM几乎立即确定了依从性问题，而提供高度个人接触的PharmCat将改善与标准治疗相比的依从性和结果。以初步的方式，我们将比较患者满意度以及提供PharmCat和MM治疗的直接成本。这项研究将导致针对该人群依从性提高的干预措施的完善。如果没有适当的遵守，就无法实现有效药物的最大益处。公共卫生的影响包括有效的疾病管理，最大化长期结局以及为精神分裂症的医疗保健费用。