A Universal Medication Schedule to Promote Adherence to Complex Drug Regimens

促进遵守复杂药物治疗方案的通用用药时间表

基本信息

批准号：
9307664
负责人：
Stacy C Bailey
金额：
$ 55.26万
依托单位：
NORTHWESTERN UNIVERSITY AT CHICAGO
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-09-15 至 2020-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9307664
关键词：
Adherence Adult Adverse drug event Adverse event Age Behavior Behavior Therapy California Chicago Chronic Chronic Disease Clinical Clinical Trials Complex Cost Analysis Counseling Dose Drug Prescriptions Effectiveness of Interventions Elderly Failure Federally Qualified Health Center Foundations Health Health Benefit Health system Healthcare Individual Institute of Medicine (U.S.)Instruction Internet Intervention Knowledge Label Life Style Link Measures Medication Errors Medicine Memory Monitor Office Nursing Online Systems Outcome Patient Monitoring Patients Periodicity Pharmaceutical Preparations Pharmacopoeias Pharmacotherapy Pharmacy facility Physicians Plant Roots Primary Health Care Problem Solving Randomized Randomized Controlled Trials Regimen Research Schedule Self Management Self Medication Standardization Statutes and Laws Structure Surveys Technology Testing Text Time Visit arm compare effectiveness compliance behavior cost design epidemiology study health literacy improved literate multiple chronic conditions programs public health relevance risk minimization tool treatment as usual

项目摘要

DESCRIPTION (provided by applicant): We will impart a Universal Medication Schedule (UMS) via increasingly available health and consumer technologies to promote patient adherence to complex prescription (Rx) drug regimens. Our team devised the UMS to simplify Rx use and help improve regimen adherence for the increasing number of adults taking complex, multi-drug regimens. The UMS standardizes the prescribing and dispensing of medicine by using health literacy principles and more explicit times to describe when to take medicine (morning, noon, evening, bedtime). This concept was highlighted by the Institute of Medicine, U.S. Pharmacopeia, and National Council for Prescription Drug Programs as a best practice. Despite considerable evidence and support for the UMS, how it may be optimally embedded in practice remains unclear. We recently tested the UMS in a clinical trial at the point of dispensing medication in pharmacy practice. Significant improvement was achieved in proper regimen use and adherence; those who were taking e 5 Rx drugs and/or were lower literate received the greatest benefit. But pharmacy was not the ideal point of implementation. Many patients use multiple pharmacies for cost or convenience, resulting in continued receipt of variable Rx information. In addition, patients would have benefited from direct guidance from their doctor on how to safely consolidate Rx regimens. Many also required basic reminders to aid memory, while others had multifaceted adherence concerns warranting periodic monitoring. We will now evaluate the independent and combined contributions of low cost, highly disseminable technologies to impart the UMS and promote adherence to multi- drug regimens at the point of prescribing in primary care. This includes: 1) leveraging an EHR to prescribe all medications with UMS Rx instructions and to provide patients with a UMS-informed medication list [EHR]; 2) sending SMS text reminders around UMS intervals [SMS]; 3) implementing a periodic regimen adherence assessment via a web-based, EHR patient portal to provide access to Rx information, monitor patient medication behaviors, and notify a clinic nurse when problems are identified [Portal]. In the proposed study, we will conduct a physician-randomized controlled trial using a 2x2 factorial design + usual care arm to compare the effectiveness of each of the above interventions, alone or in combination, to usual care and to one another. English and Spanish-speaking patients 50 and older from 1 of 3 federally qualified health centers in Chicago who take e 5 Rx drugs for chronic conditions will be randomized to receive: 1) Usual Care, 2) EHR only, 3) EHR + SMS, 4) EHR + Portal, or 5) EHR + SMS + Portal. Outcomes will be measured at baseline, 2 weeks, 1, 3, and 6 months (chart reviews at baseline and 6 months). Our specific aims are to: 1) test and compare the effectiveness of the UMS EHR tools, with or without SMS and/or Portal interventions; 2) evaluate the fidelity of each strategy and explore patient, staff, physician, and health system factors influencing the delivery of UMS interventions, alone and in combination; 3) assess the costs required to deliver the interventions.

描述（由申请人提供）：我们将通过越来越多的健康和消费者技术授予通用药物计划（UMS），以促进患者遵守复杂处方（RX）药物方案。我们的团队设计了UMS来简化RX的使用并帮助提高越来越多的成年人服用复杂，多药方案的方案。 UMS通过使用健康素养原则和更明确的时间来描述何时服药（早上，中午，晚上，睡前），将药物的处方和分配标准化。美国药物研究所和全国处方药计划委员会强调了这一概念，作为最佳实践。尽管有大量证据和对UMS的支持，但如何在实践中最佳地嵌入它仍不清楚。我们最近在药房实践中分配药物的临床试验中测试了UMS。适当的使用和依从性方面取得了显着改善；那些服用E 5 RX毒品和/或较低识字的人获得了最大的好处。但是药房并不是实施的理想点。许多患者为成本或便利性使用多个药房，导致持续收到可变的RX信息。此外，患者将从医生的直接指导中受益于如何安全地合并RX方案。许多人还需要基本的提醒来帮助记忆，而其他人则具有多方面的依从性，以保证定期监控。现在，我们将评估低成本，高度可传播技术的独立和综合贡献，以赋予UMS并促进初级保健处方处的多药方案的遵守。这包括：1）利用EHR开出所有具有UMS RX指令的药物，并为患者提供UMS知识的药物清单[EHR]； 2）向UMS间隔发送SMS文本提醒[SMS]； 3）通过基于Web的EHR患者门户网站实施定期依从性评估，以提供对RX信息的访问，监控患者药物行为，并在发现问题时通知诊所护士[Portal]。在拟议的研究中，我们将使用2x2阶乘设计 +常规护理部门进行医师随机对照试验，以将上述每种干预措施（单独或组合）的有效性与通常的护理和彼此相比。英语和西班牙语的患者在芝加哥的3个联邦合格的保健中心中的1个及以上的患者50岁以上，他们将在慢性病中服用E 5 RX药物，以便接受：1）通常的护理，2）仅EHR，3）EHR + SMS，4）EHR + Portal，或5）EHR + Portal，或5）EHR + SMS + SMS +门户。结果将在基线，2周，1、3和6个月（基线和6个月的图表审查）时测量。我们的具体目的是：1）测试和比较有或没有SMS和/或门户干预的UMS EHR工具的有效性； 2）评估每种策略的忠诚度，并探索影响UMS干预措施提供的患者，员工，医师和卫生系统因素，单独和结合； 3）评估提供干预所需的费用。