Cohort Study of Medication Adherence Among Older Adults

老年人服药依从性队列研究

• 批准号: 7931095
• 负责人: Marie Krousel-Wood
• 金额: $ 47.47万
• 依托单位: OCHSNER CLINIC FOUNDATION
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-09-01 至 2011-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7931095
• 关键词: Address; Adherence; Adult; African American; Age-Years; Aging; American; Antihypertensive Agents; Behavior Therapy; Behavioral; Cardiovascular Diseases; Cardiovascular system; Clinical; Clinical Treatment; Cohort Studies; Communication; Comorbidity; Computerized Medical Records Systems; Coronary heart disease; Data; Data Collection; Diagnosis; Disease Outcome; Economics; Elderly; End stage renal failure; Enrollment; Essential Hypertension; Female; Future; Gender; Health; Health Services Accessibility; Healthcare Systems; Hispanics; Hypertension; Hypotension; Incidence; Intervention; Knowledge; Lead; Life Style; Lifestyle Therapy; Managed Care; Manuscripts; Measures; Medical Records; Medicare; Modeling; Modification; Outcome; Participant; Patients; Perception; Pharmaceutical Preparations; Pharmacy facility; Primary Health Care; Provider; Psychosocial Factor; Quality Control; Quality of life; Race; Recruitment Activity; Relative Risks; Reporting; Risk; Risk Factors; Sampling; Severities; Sex Functioning; Stroke; Structure; Surveys; System; Telephone; Therapeutic; Treatment Factor; blood pressure regulation; computerized; copayment; design; eligible participant; follow-up; health care service utilization; improved; male; medication compliance; modifiable risk; mortality; primary outcome; prospective; psychosocial; quality assurance; racial difference; satisfaction; social

DESCRIPTION (provided by applicant): At least 50 million adult Americans have hypertension, an important modifiable risk factor for coronary heart disease, stroke and end-stage renal disease. Efficacious blood pressure lowering medications are available but low adherence to medication by older adults can lead to poor outcomes.The overall objective of the proposed prospective cohort study is to determine factors that are associated with reduced antihypertensive medication adherence among older adults (>=65 years). The factors to be investigated include psychosocial, behavioral, quality of life (QOL), health care system issues including copayment/benefit, knowledge, sexual function (SF), medication class, use of unconventional therapies/lifestyle modifications.and clinical factors. The impact of these factors will be assessed overall and by gender and race. We propose to conduct a prospective cohort study with 2,000 participants >= 65 years of age with diagnosed essential hypertension (HTN) in a managed care organization (MCO). This study is designed to have 80% statistical power to detect relative risks of less than 1.5 of medication adherence at baseline and less than 2.0 for transitioning from high to medium or medium to low adherence over 2 years of follow-up associated with demographic, behavioral, clinical and treatment factors. A random, race-and gender- stratified sample of HTN patients >=65 years enrolled in the Medicare Risk Product of a large southern MCO will be selected from all eligible participants. Patients will be followed prospectively for an average of 2 years and medication adherence, QOL , SF, demographic, treatment, socio-economic, knowledge, clinical and behavioral factors will be determined at baseline and during annual telephone-administered follow-up surveys. Chart abstraction at baseline and follow-up will be used to assess blood pressure control, cardiovascular outcomes and HTN severity. MCO computerized medical record system will be used toaccess data on HTN medications, cardiovascular outcomes, copayment/benefit and utilization. The primary outcome will be medication adherence at baseline and changes in medication adherence during follow-up. In addition, the impact of medication adherence at baseline on blood pressure control, QOL, utilization, and cardiovascular outcomes during follow-up will be examined. Results of this study will lay the groundwork for interventions to improve medication adherence and clinical outcomes in older adults with hypertension and will increase our understanding of factors contributing to therapeutic outcomes in the use of medications by these patients.

描述（由申请人提供）：至少有5000万成年美国人患有高血压，这是冠心病，中风和终末期肾脏疾病的重要修改风险因素。可以使用有效的血压降低药物，但是老年人对药物的依从性较低可能导致较差的结果。拟议的前瞻性队列研究的总体目标是确定与老年人降低降压药物依从性降低相关的因素（> = 65岁）。要调查的因素包括社会心理，行为，生活质量（QOL），医疗保健系统问题，包括共付额/福利，知识，性功能（SF），药物类别，使用非常规疗法/生活方式修改以及临床因素。这些因素的影响将通过整体以及性别和种族评估。我们建议对2,000名参与者进行一项前瞻性队列研究，> = 65岁，在托管护理组织（MCO）中诊断为基本高血压（HTN）。这项研究旨在具有80％的统计能力，可在基线时检测相对风险少于1.5的药物依从性，而在与人口，行为，临床和治疗因素相关的2年中，从高到中或低依从性过渡的相对风险小于2.0。将从所有合格的参与者中选择一个随机，种族和性别分层的HTN患者> = 65岁的Medicare风险产品。将预期遵循2年的前瞻性遵循，QOL，SF，人口统计学，治疗，社会经济，知识，临床和行为因素将在基线和年度电话管理的随访调查中确定。基线和随访时的图表抽象将用于评估血压控制，心血管结局和HTN严重程度。 MCO计算机病历系统将用于有关HTN药物，心血管结果，共付额/福利和利用的访问数据。主要结果将是基线时的药物依从性以及随访期间药物依从性的变化。此外，将检查药物依从性对血压控制，QOL，利用率和心血管结局的影响。这项研究的结果将为干预措施奠定基础，以改善高血压老年人的药物依从性和临床结局，并将提高我们对这些患者使用药物治疗结果的因素的理解。

项目成果

Medication Adherence in Older Adults: A Qualitative Study.

• DOI: 10.1080/03601277.2013.802186
• 发表时间: 2014-01-01
• 期刊: Educational gerontology
• 影响因子: 1.5
• 作者: Holt EW;Rung AL;Leon KA;Firestein C;Krousel-Wood MA
• 通讯作者: Krousel-Wood MA

Development and evaluation of a self-report tool to predict low pharmacy refill adherence in elderly patients with uncontrolled hypertension.

• DOI: 10.1002/phar.1275
• 发表时间: 2013-08
• 期刊: PHARMACOTHERAPY
• 影响因子: 4.1
• 作者: Krousel-Wood, Marie;Joyce, Cara;Holt, Elizabeth W.;Levitan, Emily B.;Dornelles, Adriana;Webber, Larry S.;Muntner, Paul
• 通讯作者: Muntner, Paul

Does waiver of written informed consent from the institutional review board affect response rate in a low-risk research study?

• DOI: 10.2310/6650.2006.05031
• 发表时间: 2006-05-01
• 期刊: JOURNAL OF INVESTIGATIVE MEDICINE
• 影响因子: 2.6
• 作者: Krousel-Wood, Marie;Muntner, Paul;Breault, Joseph
• 通讯作者: Breault, Joseph

Predictors of decline in medication adherence: results from the cohort study of medication adherence among older adults.

• DOI: 10.1161/hypertensionaha.111.176859
• 发表时间: 2011-11
• 期刊: Hypertension (Dallas, Tex. : 1979)
• 作者: Krousel-Wood M;Joyce C;Holt E;Muntner P;Webber LS;Morisky DE;Frohlich ED;Re RN
• 通讯作者: Re RN

Barriers to and determinants of medication adherence in hypertension management: perspective of the cohort study of medication adherence among older adults.

• DOI: 10.1016/j.mcna.2009.02.007
• 发表时间: 2009-05
• 期刊: The Medical clinics of North America
• 作者: Krousel-Wood MA;Muntner P;Islam T;Morisky DE;Webber LS
• 通讯作者: Webber LS