Adaptation, Education and Motivation: Improving Evidence-Based Medication Adhere

适应、教育和动机：改善循证药物坚持

• 批准号: 8009615
• 负责人: ROBERT M MAYBERRY
• 金额: $ 149.31万
• 依托单位: MOREHOUSE SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-01 至 2013-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8009615
• 关键词: Adaptation; Education; Motivation; Improving; Evidence

DESCRIPTION (provided by applicant): The proposed adaptation and dissemination project builds on previous research aimed at improving diabetes care quality at a local federally-quality community health center, providing care to this predominately low income, urban African American population. Our intent in this proposed project is to adapt and customize CERSGs for Consumers and Clinicians: Consumer Guides "Pills for Type 2 Diabetes" and "Premix Insulin for Type 2 Diabetes" and Clinician Guides "Comparing Oral Medications for Adults with Type 2 Diabetes" and "Premixed Insulin Analogues." The CERSGs will be adapted within the socio-cultural context of routine provision of care within this healthcare organization (West End Medical Centers (WEMC)) and in doing so impact overall diabetes care quality. The project objective is to incorporate evidence-based medication use into patient self-care, the WEMC Diabetes Self-Management Education (DSME) Program, and the decision support functions of the EMR system. The primary aims are to 1) improve the rate of scheduled diabetes care follow-up visits, to enhance the opportunity for anti-diabetes treatment and treatment intensification, 2) increase medication knowledge and awareness, 3) improve patient communication with the provider regarding medication use and 4) improve adherence to CERSGs prescribed medications. The secondary aims are to 1) increase participation and completion rates of WEMC DSME classes where medication adherence behaviors are reinforced and 2) to improve prescription documentation of CERSGs oral and insulin medications in the EMR systems for periodic review and assessment of evidence-based prescribing practice. We propose a community health work (CHW) model with the innovation of MI to deliver the content of CERSGs to adults with type 2 diabetes. The CHW intervention will be delivered according to the psycho-social needs and stage of readiness of the project participants and for the purpose of facilitating motivation for adherence to prescribed anti-diabetes medications. Despite current efforts at WEMC, diabetes care quality remained suboptimal, the missed appointment rate is high and medication adherence is at 20%. Participation in and completion of DSME classes are poor, and care quality and prescribed medications are poorly documented in the EMR system. The CHW intervention is expected to improve the rate of diabetes care follow-up visits, knowledge and aware of evidence-based medication use, patient communication, medication adherence, and participation in DSME classes where medication adherence will be reinforced. Adaptation CERSGs is expected to be further enhanced by incorporating CERSGs for providers into the EMR system, provide web-base training for clinicians, and audit medications problems, and conduct feedback discussion of medication adherence and patient-provider communication issues, e.g., during "Lunch and Learn" (Figure 1). Two major hypotheses will be tested in this proposed research and dissemination project: 1) the CHW intervention model will increase medication knowledge and awareness, increase patient communication with the provider, reduce medication problems, and improve medication adherence and 2) intrinsic motivation will be actualized among patients assigned to the CHW-MI group, which will results in better medication adherence relative to the patients receiving general diabetes education by the CHW. PUBLIC HEALTH RELEVANCE: The proposed adaptation research and dissemination project will adapt, customize, and deliver the content of CERSGs for oral and insulin medications, aimed at enhancing prescribed medication adherence among a vulnerable population of low-income, urban African American adults with type 2 diabetes. The primary goal of the project is to prevent or delay microvascular complications of diabetes, an increasing prevalent disease burden.

描述（由申请人提供）：拟议的适应和传播项目以先前的研究为基础，旨在提高当地联邦质量的社区卫生中心的糖尿病护理质量，为主要是低收入的城市非裔美国人提供护理。我们在此拟议项目中的目的是为消费者和临床医生调整和定制 CERSG：消费者指南“2 型糖尿病药丸”和“2 型糖尿病预混胰岛素”以及临床医生指南“比较成人 2 型糖尿病口服药物”和“预混合胰岛素类似物。” CERSG 将在该医疗保健组织（西区医疗中心 (WEMC)）内常规提供护理的社会文化背景下进行调整，从而影响整体糖尿病护理质量。该项目的目标是将循证药物使用纳入患者自我护理、WEMC 糖尿病自我管理教育 (DSME) 计划以及 EMR 系统的决策支持功能中。主要目标是 1) 提高定期糖尿病护理随访率，增加抗糖尿病治疗和强化治疗的机会，2) 提高药物知识和意识，3) 改善患者与提供者有关药物的沟通4) 提高对 CERSG 处方药物的依从性。次要目标是 1) 提高 WEMC DSME 课程的参与率和完成率，从而强化用药依从行为；2) 改进 EMR 系统中 CERSG 口服和胰岛素药物的处方记录，以便定期审查和评估循证处方实践。我们提出了一种具有 MI 创新的社区卫生工作 (CHW) 模式，向 2 型糖尿病成人提供 CERSG 的内容。 CHW 干预将根据项目参与者的心理社会需求和准备阶段进行，目的是促进坚持服用处方抗糖尿病药物的动力。尽管 WEMC 当前做出了努力，但糖尿病护理质量仍然不理想，错过预约率很高，药物依从率为 20%。 DSME 课程的参与和完成率很低，EMR 系统中的护理质量和处方药物记录也很少。 CHW 干预预计将提高糖尿病护理随访率、对循证药物使用的知识和认识、患者沟通、药物依从性以及参与 DSME 课程，以加强药物依从性。通过将提供者的 CERSG 纳入 EMR 系统、为临床医生提供基于网络的培训、审核药物问题以及对药物依从性和患者与提供者沟通问题进行反馈讨论（例如，在“午餐”期间），预计将进一步增强适应 CERSG。并学习”（图1）。在这个拟议的研究和传播项目中将测试两个主要假设：1）社区卫生工作者干预模式将增加用药知识和意识，增加患者与提供者的沟通，减少用药问题，并提高用药依从性；2）内在动机将得到实现与接受 CHW 一般糖尿病教育的患者相比，这将导致分配到 CHW-MI 组的患者有更好的药物依从性。 公共卫生相关性：拟议的适应研究和传播项目将调整、定制和提供口服和胰岛素药物的 CERSG 内容，旨在提高低收入城市非洲裔美国成人 2 型弱势群体的处方药物依从性糖尿病。该项目的主要目标是预防或延缓糖尿病的微血管并发症，这是一种日益增加的普遍疾病负担。