A Smartphone Intervention to Improve Adherence to Antipsychotic Medications

智能手机干预可提高抗精神病药物的依从性

• 批准号: 8322588
• 负责人: JULIE A. KREYENBUHL
• 金额: $ 20.34万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-08-15 至 2014-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8322588
• 关键词: Adherence; Adult; Adverse effects; American; Antipsychotic Agents; Asthma; Behavior; Behavioral; Car Phone; Cellular Phone; Communication; Computers; Data; Diabetes Mellitus; Evaluation; Exhibits; Family; Future; Goals; HIV; Health; Health Care Costs; Healthcare; Hospitalization; Impairment; Individual; Internet; Intervention; Laboratories; Lead; Medical; Medication Management; Mental Health; Minority; Modeling; Monitor; Motivation; National Institute of Mental Health; Outcome; Outcomes Research; Participant; Patients; Perception; Pharmaceutical Preparations; Pharmacy facility; Population; Psychiatrist; Randomized; Recovery; Relapse; Relative (related person); Research; Resources; Risk Behaviors; Schizophrenia; Secure; Self Management; Societies; Symptoms; Technology; Telephone; Testing; Vision; adverse outcome; base; clinical practice; digital; flexibility; improved; medication compliance; neuropsychological; novel strategies; pilot trial; response; severe mental illness; shared decision making; skills; smoking cessation; usability; user centered design

DESCRIPTION (provided by applicant): Up to 60% of individuals with schizophrenia do not take their antipsychotic medications as prescribed, which can lead to symptom relapse, decreased functioning, hospitalization, and increased healthcare costs. Recent studies of both patient- and pharmacy-based interventions utilizing behavioral tailoring, environmental supports, and medication monitoring have shown promise in improving antipsychotic adherence. However, there is continued need for effective adherence-enhancing interventions (AEIs) that are less resource intensive and more widely accessible by the broad range of individuals in need of assistance with medication management. Over the last decade, technological advances in internet and cellular communication, including the emergence of mobile 'smartphones', have revolutionized the way our society communicates. Whereas a variety of mobile phone-based applications have been shown to be effective for improving health outcomes such as medication adherence for a number of medical conditions, few such applications have been developed for individuals with schizophrenia. Therefore, in response to NIMH PAR-09-173, we propose to develop and pilot test the effect of a mobile smartphone intervention, MedActive, on improving antipsychotic adherence among this population. We used the Information-Motivation-Behavioral (IMB) Skills Model of adherence as the theoretical framework to inform the conceptualization of MedActive. The IMB Skills Model posits that individuals who are well-informed and motivated to adhere will enact adherence-related behavioral skills that lead to adherence behaviors and favorable health outcomes. MedActive will provide personalized reminders to patients to take their antipsychotic medications as prescribed and will query them about their intentions to take the medication, the occurrence of side effects, and the presence of positive psychotic symptoms. Summaries of these ecological momentary assessments of adherence, symptoms, and side effects will be made available to the individual on the phone and to their psychiatrist through a secure, online clinician interface. Using an iterative user-centered design approach, the specific aims of this proposal are to (1) collaborate with individuals with schizophrenia, psychiatrists and an expert advisory group to develop the initial version of MedActive; (2) conduct laboratory usability testing and a short-term field trial in 10 individuals with schizophrenia and their psychiatrists to determine the preliminary acceptability and feasibility of MedActive in clinical practice; and (3) conduct a randomized pilot trial of MedActive compared to providing a smartphone alone in 40 individuals with schizophrenia and their psychiatrists to evaluate its effect on antipsychotic adherence. We will also explore whether psychiatric symptoms and neuropsychological impairments moderate the effect of MedActive on adherence. If shown to be effective, MedActive will introduce a paradigm shift in medication self-management by individuals with schizophrenia and in treatment monitoring by their clinicians.

描述（由申请人提供）：多达60％的精神分裂症患者没有按照处方服用抗精神病药物，这可能导致症状复发，功能降低，住院和医疗保健费用增加。对使用行为剪裁，环境支持和药物监测的患者和药房干预措施的最新研究表明，有望改善抗精神病药物。但是，继续需要有效的依从性干预措施（AEI），这些干预措施的资源密集程度较低，并且需要广泛需要药物管理协助的人来访问。在过去的十年中，包括移动“智能手机”在内的互联网和蜂窝通信的技术进步彻底改变了我们社会交流的方式。尽管已经证明各种基于手机的应用程序可有效地改善健康状况，例如在许多医疗状况中依从性，但对于精神分裂症患者，几乎没有开发此类应用。因此，在响应NIMH PAR-09-173时，我们建议开发和试点测试移动智能手机干预（Medactive）对改善该人群中抗精神病药依从性的影响。我们将依从性的信息动机行为（IMB）技能模型用作理论框架，以告知医疗的概念化。 IMB技能模型认为，良好信息和动力遵守的个人将发挥与依从性相关的行为技能，从而导致依从性行为和有利的健康成果。 Medactive将为患者提供个性化提醒，以便服用其抗精神病药，并会向他们询问他们的意图服用药物，副作用的发生以及存在阳性精神病症状。这些生态瞬时评估的依从性，症状和副作用的摘要将通过电话通过安全的在线临床医生界面提供给个人以及他们的精神科医生。使用以用户为中心的迭代设计方法，该提案的具体目的是（1）与精神分裂症，精神科医生和专家咨询小组的个人合作，以开发Medactive的初始版本； （2）对10名精神分裂症患者及其精神科医生进行实验室可用性测试和短期现场试验，以确定Medactive在临床实践中的初步可接受性和可行性； （3）与仅在40名精神分裂症患者及其精神科医生中提供智能手机相比，进行了一项随机的Medactive试验试验，以评估其对抗精神病性依从性的影响。我们还将探索精神病症状和神经心理学障碍是否适应了差异对依从性的影响。如果证明是有效的，Medactive将引入精神分裂症患者和临床医生治疗监测的药物自我管理的范式转移。