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

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）：抗精神病药物依从性差可能导致精神分裂症患者复发、再住院和预后不良。我们已经证明，在认知适应训练 (CAT) 计划及其对应的仅关注药物依从性的 PharmCAT 计划中使用环境支持（标志、警报、物品整理）可提高依从性和结果。 PharmCAT 包括每周家访，以建立和维持环境支持，绕过认知和情境问题，并提示按处方服用药物。我们的目标是开发最具成本效益的方法来提高依从性。新技术，如 Med-eMonitor(tm) 是一种专门的药丸容器（能够提示服药，在患者服用错误药物或在错误时间服用药物时发出警告，记录副作用投诉，并通过自动下载到一个安全网站，及时提醒治疗人员未按规定服药）是与 PharmCAT 治疗中所做操作的电子模拟。使用更多依赖技术而不是治疗人员上门拜访的 MM 可能有助于为更广泛的患者提供环境支持。我们将 150 名服用非典型抗精神病药物的患者随机分配到 3 个治疗组之一，为期 9 个月：1) PharmCAT、2) Med-eMonitor (MM) 或 3) 标准治疗 (SO)。主要结果变量包括抗精神病药物的依从性、伴随药物的依从性和社区结果。混合模型的协方差重复测量分析将用于检查治疗期间结果变量的组间差异，并将治疗前评分用作协变量。我们假设，与标准治疗相比，几乎立即识别依从性问题的 MM 和提供高度个人接触的 PharmCAT 都将提高依从性和结果。我们将初步比较患者满意度以及提供 PharmCAT 和 MM 治疗的直接成本。这项研究将完善干预措施，以提高该人群的依从性。如果没有适当的坚持，就无法实现有效药物的最大益处。公共卫生影响包括有效的疾病管理、最大限度地提高长期结果以及控制精神分裂症的医疗保健费用。