Development of a novel medication adherability tool to improve cardiovascular disease management

开发新型药物依从性工具以改善心血管疾病管理

• 批准号: 9886260
• 负责人: Julie Christine Lauffenburger
• 金额: $ 14.36万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-04-17 至 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9886260
• 关键词: Address; Adherence; Adopted; Affect; Appearance; Behavior Therapy; Behavioral Sciences; Biometry; Cardiovascular Diseases; Cardiovascular system; Cause of Death; Characteristics; Clinical; Color; Consumption; Data; Data Sources; Decision Making; Deglutition; Development; Disease; Disease Management; Dose; Electronic Health Record; Ensure; Epidemic; Epidemiology; Focus Groups; Frequencies; Future; Goals; Health; Heart Diseases; Internet; Intervention; Lead; Machine Learning; Medicine; Mentors; Mentorship; Methods; Mission; National Heart, Lung, and Blood Institute; Outcome; Outpatients; Palate; Patients; Pharmaceutical Preparations; Pharmacists; Property; Provider; Regimen; Reporting; Research; Review Literature; Risk; Route; Shapes; Testing; Time; Training; Work; base; behavior change; cardiometabolism; clinical decision support; clinical decision-making; design; health belief; implementation research; improved; individual patient; individualized medicine; innovation; medication compliance; mortality; novel; novel strategies; predictive modeling; programs; prophylactic; side effect; success; successful intervention; support tools; systematic review; theories; tool; virtual

Nearly half of patients with heart disease become non-adherent to their prescribed therapies within a year of treatment initiation. This is a central and modifiable reason why cardiovascular disease remains a leading cause of death in the US. Despite numerous attempts to develop interventions aimed at improving adherence, these attempts have had varying and often limited success; one explanation could be that underlying barriers to adherence are not being addressed. Those interventions that have been successful often make medications easier to take but are frequently expensive to implement or deployed too late. Developing a novel provider- facing intervention that modifies medication “adherability”, defined as the properties of medications that make them difficult for patients to take, could be especially impactful and relatively inexpensive. For example, more than 30% of patients report difficulties swallowing prescribed medicines, yet little is known how this “adherability” affects long-term adherence and clinical outcomes, and few interventions focus on these issues. To this end, Dr. Lauffenburger’s K01 proposal incorporates a novel prophylactic, patient-centric approach to provider behavior change for cardiovascular disease management. Providers often do not know what the medications they prescribe actually look like or what aspects of the medications are acceptable to or preferred by their patients. This study will uniquely incorporate patient perspectives about medication properties that lead to poor adherence in the design of a scalable provider-facing clinical decision support intervention. The proposed aims are to: (1) develop a comprehensive framework of cardiovascular medication properties, such as appearance, side-effect profiles, or dosing, that may lead to poor adherence using patient focus groups; (2) rigorously evaluate their effects on adherence and clinical outcomes in large national data sources; (3) develop and externally validate a novel clinical prediction rule for medication adherability; and (4) develop and pilot test novel web- and electronic health record-based prescribing tools based on the prediction rule for providers. The expected overall impact of this innovative proposal is that it will fundamentally advance how to personalize medications for patients to ultimately improve adherence and health outcomes. Dr. Lauffenburger has a unique background as a practicing pharmacist trained in epidemiology with a proven commitment to research. This proposal includes an educational plan that will address gaps in her training: expertise in behavioral sciences, prediction modeling, and implementation research. The mentorship team, led by Niteesh Choudhry, an expert in adherence and implementation, includes well-known experts in cardiovascular trials (Elliott Antman, co-mentor), biostatistics (Robert Glynn, co-mentor), and behavioral sciences (Daniel Solomon, co-mentor), and will ensure scientific success and training. By the conclusion of this program, she will be able to independently design, target, and evaluate behavioral interventions for heart diseases. The results of the proposed K01 will be invaluable pilot work for a planned R01-level application.

近一半的心脏病患者在一年内不再遵守规定的治疗 这是心血管疾病仍然是主要疾病的一个核心且可改变的原因。 尽管人们多次尝试制定旨在提高依从性的干预措施， 这些尝试取得了不同程度的成功，而且往往是有限的；一种解释可能是存在潜在的障碍； 那些成功的干预措施通常会导致药物依从性的问题得到解决。 更容易采用，但实施起来往往成本高昂，或者部署得太晚。 面临改变药物“依从性”的干预，“依从性”定义为药物的特性， 例如，它们对患者来说难以服用，但可能特别有影响力且相对便宜。 超过 30% 的患者报告吞咽处方药物有困难，但很少有人知道这是如何发生的 “依从性”影响长期依从性和临床结果，很少有干预措施关注这些问题。 为此，Lauffenburger 博士的 K01 提案采用了一种新颖的、以患者为中心的预防方法 心血管疾病管理的提供者行为改变 提供者通常不知道什么是心血管疾病管理。 他们开出的药物实际上看起来很像，或者药物的哪些方面是可以接受或首选的 这项研究将独特地纳入患者对药物特性的看法。 面向提供者的可扩展临床决策支持干预设计的依从性较差。 拟议的目标是：（1）制定心血管药物的综合框架 可能导致患者依从性差的特性，例如外观、副作用或剂量 焦点小组；(2) 在大型国家数据中严格评估其对依从性和临床结果的影响 来源；(3) 开发并外部验证药物依从性的新临床预测规则；以及 (4) 根据预测开发和试点测试基于网络和电子健康记录的新型处方工具 这项创新提案的预期总体影响是，它将从根本上推进。 如何为患者提供个性化药物治疗，以最终提高依从性和健康结果。 Lauffenburger 博士作为一名受过流行病学培训的执业药剂师，拥有独特的背景。 该提案包括一项教育计划，该计划将解决她的差距。 培训：行为科学、预测建模和实施研究方面的专业知识。 由遵守和实施专家 Niteesh Choudhry 领导的团队包括以下领域的知名专家： 心血管试验（Elliott Antman，共同导师）、生物统计学（Robert Glynn，共同导师）和行为学 科学（丹尼尔·所罗门，共同导师），并将确保科学的成功和培训。 计划后，她将能够独立设计、瞄准和评估心脏的行为干预措施 拟议的 K01 的结果对于计划的 R01 级应用来说将是非常宝贵的试点工作。