mHealth for Diabetes Adherence Support

移动医疗对糖尿病依从性的支持

• 批准号: 9173976
• 负责人: Ben Steven Gerber
• 金额: $ 70.24万
• 依托单位: UNIVERSITY OF ILLINOIS AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-07-15 至 2021-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9173976
• 关键词: Address; Adherence; Adopted; Adoption; Adult; African American; American; Behavior; Blood Pressure; Car Phone; Caring; Case Manager; Cholesterol; Clinic; Clinical; Clinical Pharmacists; Communication; Communications Media; Communities; Complex; Costs and Benefits; Data; Diabetes Mellitus; Educational process of instructing; Effectiveness; Face; Glycosylated hemoglobin A; Goals; Health; Health Sciences; Health Technology; Health education; Healthcare; Healthcare Systems; Healthy Eating; Home environment; Home visitation; Hospitals; House Call; Illinois; Intervention; LDL Cholesterol Lipoproteins; Latino; Life Style; Low income; Maintenance; Mediation; Medical; Medical Nutrition Therapy; Minority; Modeling; Monitor; Non-Insulin-Dependent Diabetes Mellitus; Nurses; Outcome; Outcome Measure; Patients; Persons; Pharmaceutical Preparations; Pharmacists; Pharmacotherapy; Pharmacy facility; Physical activity; Physicians; Physiological; Problem Solving; Randomized; Randomized Controlled Trials; Research; Resources; Role; Secure; Self Management; Services; Social support; Support Groups; System; Telephone; Text; Therapeutic; Time; Transportation; United States National Institutes of Health; Universities; Videoconferences; Videoconferencing; Visit; Work; base; burden of illness; cost; cost effectiveness; design; diabetes management; disorder risk; effective intervention; empowered; experience; good diet; health care service; healthy lifestyle; high risk; improved; improved outcome; innovation; mHealth; medication compliance; meetings; novel; patient oriented; peer; psychosocial; response; skills; therapy design; treatment as usual

PROJECT SUMMARY Many African-Americans and Latinos with diabetes do not achieve recommended diabetes goals placing them at high risk for complications. Team-based models of care can help in reaching goals of therapy. Additionally, mobile health (mHealth) technologies can further improve outcomes among those more difficult to reach. This study will evaluate the impact of a team-based, mHealth intervention designed to improve medication adherence, healthy eating, and physical activity behaviors. We will compare this mHealth approach with usual care. Clinical pharmacists and health coaches (HC) will deliver our proposed team-based intervention. mHealth delivery includes mobile phone text messaging, secure videoconferencing, and HC home visits. Pharmacists will focus on medication reconciliation and adherence. Health coaches will help identify psychosocial and environmental challenges to adherence in a culturally-sensitive manner. Together, they can assist in goal-setting, problem-solving, negotiation of competing priorities, and provide social support leveraging mHealth technologies. Preliminary data from our research group supports the role of health coaches partnering with clinic- based pharmacists in improving diabetes outcomes in minorities. In the proposed mHealth intervention, patient- pharmacist videoconferencing will eliminate the need for in-person visits with a pharmacist, which is impractical for many low-income patients. In addition, our pilot work suggests that text messaging is a preferable means of communication and may facilitate more frequent contact with patients. We propose a randomized, controlled trial to evaluate the effectiveness of an mHealth diabetes adherence support intervention delivered by clinical pharmacists and health coaches. We will randomize 220 patients through UI Health to either: (1) mHealth diabetes adherence support through clinical pharmacists and health coaches; or (2) usual care. After one year, patients completing the mHealth intervention will be monitored for an additional year while the usual care group receives the mHealth approach. Outcomes include medication adherence, hemoglobin A1c, blood pressure, and LDL-cholesterol levels. The specific aims include: (1) evaluate the effectiveness of an mHealth diabetes adherence support intervention delivered by clinical pharmacists and health coaches to African-American and Latino adults with uncontrolled type 2 diabetes; (2) evaluate the maintenance of improved diabetes behaviors as well as clinical outcomes one year after completing the intervention; (3) evaluate the cost and cost-effectiveness of mHealth diabetes adherence support compared to usual care; and (4) evaluate the reach, adoption, and implementation of mHealth diabetes adherence support based on the RE-AIM framework.

项目概要 许多患有糖尿病的非洲裔美国人和拉丁裔美国人没有达到建议的糖尿病目标 使他们面临并发症的高风险。基于团队的护理模式有助于实现治疗目标。 此外，移动医疗（mHealth）技术可以进一步改善那些更难以治疗的人的结果 抵达。这项研究将评估基于团队的移动医疗干预措施的影响，旨在改善 药物依从性、健康饮食和身体活动行为。我们将比较这个 mHealth 平常小心地接近。 临床药剂师和健康教练 (HC) 将提供我们建议的基于团队的干预措施。 移动医疗服务包括手机短信、安全视频会议和 HC 家访。 药剂师将重点关注药物协调和依从性。健康教练将帮助识别 以文化敏感的方式坚持的心理社会和环境挑战。在一起，他们可以 协助设定目标、解决问题、谈判优先事项并提供社会支持 利用移动医疗技术。 我们研究小组的初步数据支持健康教练与诊所合作的作用 基础药剂师改善少数族裔糖尿病的结果。在拟议的移动医疗干预中，患者 药剂师视频会议将消除亲自拜访药剂师的需要，这是不切实际的 对于许多低收入患者来说。此外，我们的试点工作表明，短信是一种更好的方式 沟通，并可能促进与患者更频繁的接触。 我们提出一项随机对照试验来评估移动健康糖尿病的有效性 由临床药剂师和健康教练提供的依从性支持干预。我们将随机抽取 220 个 患者通过 UI Health 可以获得：(1) 通过临床药剂师提供 mHealth 糖尿病依从性支持，以及 健康教练；或 (2) 日常护理。一年后，完成移动医疗干预的患者将 在常规护理组接受移动医疗方法的同时，再进行一年的监测。结果包括 药物依从性、糖化血红蛋白、血压和低密度脂蛋白胆固醇水平。具体目标包括： (1) 评估临床提供的 mHealth 糖尿病依从性支持干预措施的有效性 为患有未受控制的 2 型糖尿病的非裔美国人和拉丁裔成年人提供药剂师和健康教练； (2) 评估改善糖尿病行为的维持情况以及一年后的临床结果 完成干预； (3)评估mHealth糖尿病依从性的成本和成本效益 与常规护理相比的支持； (4) 评估移动医疗的覆盖范围、采用和实施 基于 RE-AIM 框架的糖尿病依从性支持。