Interactive Tele-Pharmacy to Improve Chronic Medication Adherence

交互式远程药房可提高慢性药物依从性

基本信息

批准号：
8696055
负责人：
Niteesh K Choudhry
金额：
$ 69.44万
依托单位：
BRIGHAM AND WOMEN'S HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-06-01 至 2018-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8696055
关键词：
Achievement Address Adherence Adult Ambulatory Health Center Antihypertensive Agents Blood Pressure Caring Cholesterol Chronic Chronic Care Clinical Clinical Pharmacists Clinical Trials Design Collaborations Communication Complex Computer Simulation Data Diabetes Mellitus Effectiveness of Interventions Electronic Health Record Electronic Mail Future Glycosylated hemoglobin A Goals Group Practice Health behavior change Home environment Hypertension Hypoglycemic Agents Individual Information Technology Insurance Intervention Investments Knowledge Life Expectancy Link Long-Term Effects Mails Massachusetts Measures Medical Methods Modeling Myocardial Infarction Nature Oral Outcome Outcome Measure Patient Care Patient Self-Report Patients Pharmaceutical Preparations Pharmacists Pharmacy facility Physicians Population Primary Care Physician Primary Health Care Quality-Adjusted Life Years Randomized Randomized Controlled Trials Records Recruitment Activity Regimen Research Sampling Secure Stroke Surveys System Technology Testing Text Touch sensation Validation Visit base cholesterol control clinically relevant cost cost effectiveness design disorder control effective intervention effective therapy health information technology hypercholesterolemia improved innovation insight medication compliance multi-component intervention novel outreach program patient oriented patient population population based primary care setting programs public health relevance routine practice skills success virtual volunteer willingness

项目摘要

DESCRIPTION (provided by applicant): Nearly half of patients become non-adherent to their prescribed therapies within a year of treatment initiation. Unfortunately, the success of existing interventions to address this problem has been relatively limited, either because of the nature of the intervention or their broad applications to patients who do not require them or will not benefi from them. The efficacy of future efforts is likely to be increased by targeting interventions to non-adherent patients with poor or worsening control of their chronic conditions and tailoring interventions to individual patients based upon the willingness and ability to improve their adherence. Because the most effective interventions appear to be those that are multi-faceted and thus often complex, there is also a need for multimodal interventions that are simple and which can be integrated into routine practice. The validation of adherence measures that are not based upon administrative claims data, but which can be derived from self-reported adherence or rapidly available and routinely collected pharmacy transaction records, is also a priority. To this end, we propose a cluster randomized controlled trial (RCT) of a novel tele-pharmacist based intervention to improve adherence to medications for hypercholesterolemia, hypertension, and diabetes. This application builds on many years of research by our group on improving medication use and evaluating novel interventions in existing real-world delivery systems. The intervention will integrate the use of the electronic health record (EHR) and pharmacy claims data to identify approximately 3,000 adult patients cared for by approximately 150 primary care physicians who are both non-adherent and not achieving recommended clinical targets for glycemic, blood pressure, and cholesterol control in a real-world primary care setting. Following EHR-facilitated referral from the treating primary care physicians, a clinical pharmacist will direct an outreach program using multiple communication technologies including text messaging, secure email, mail, and "video visits" with the intensity of the intervention tailored to the patient's level of "activation". The aims of the study are to: (1) implement and evaluate the ability of a novel tele-pharmacist intervention in a multispeciality group practice to improve adherence and clinically relevant outcomes, (2) assess the cost- effectiveness of the intervention, and (3) validate the ability to use retail pharmacy filling data and self-reported daa to evaluate adherence. Using a rigorous randomized design, we have proposed a feasible and sustainable intervention that links adherence to clinically relevant outcome measures as a core component of the program. As the nation considers substantial investments in health information technology and primary care based population management, our intervention will provide important insights into how to effectively improve medication adherence and ultimately, chronic care outcomes.

描述（由申请人提供）：近一半的患者在治疗开始后的一年内对他们的处方疗法不遵守。不幸的是，现有干预措施解决此问题的成功是相对有限的，要么是因为干预的性质或对不需要他们或不会从中受益的患者的广泛应用。通过针对对其慢性疾病差或恶化控制的非依从性患者的干预措施，可能会提高未来努力的功效，并根据提高其依从性的意愿和能力来调整对个别患者的干预措施。由于最有效的干预措施似乎是多方面的干预措施，因此通常是复杂的，因此还需要简单的多模式干预措施，这些干预措施可以整合到常规实践中。不是基于行政索赔数据的依从性衡量标准的验证，但可以从自我报告的依从性或迅速获得并经常收集的药学交易记录中得出。为此，我们提出了一项基于远程药物的新型干预措施的簇随机对照试验（RCT），以提高对高胆固醇血症，高血压和糖尿病的依从性。该应用程序建立在我们小组在改善药物使用和评估现有现实世界中的新干预措施方面的多年研究。干预措施将整合使用电子健康记录（EHR）和药房索赔数据，以识别大约3,000名不遵守且无法实现针对血糖，血压和胆固醇控制的临床目标的大约150名初级保健医生所照顾的成年患者环境。经过治疗的初级保健医生的EHR转诊后，临床药剂师将使用多种通信技术指导一项外展计划，包括文本消息，安全电子邮件，邮件和“视频访问”，并具有针对患者的“激活”水平量身定制的干预措施的强度。该研究的目的是：（1）实施和评估新型远程药物干预在多特殊性群体实践中的能力提高依从性和临床相关结果，（2）评估干预措施的成本有效性，（3）验证使用零售药房填充数据和自我报告的DAA的能力来评估依从性。使用严格的随机设计，我们提出了可行且可持续的干预措施，将依从性与临床相关的结果指标联系起来，作为该计划的核心组成部分。随着国家考虑对健康信息技术和基于初级保健的人群管理的大量投资，我们的干预将为如何有效改善药物依从性以及最终的慢性护理结果提供重要的见解。