Longitudinal study of determinants of medication adherence in COPD

COPD 药物依从性决定因素的纵向研究

基本信息

批准号：
9306933
负责人：
Michelle Nuttall Eakin
金额：
$ 68.84万
依托单位：
JOHNS HOPKINS UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-04-01 至 2021-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9306933
关键词：
Address Adherence Affect Asthma Behavior Therapy Belief Cause of Death Characteristics Chronic Disease Chronic Obstructive Airway Disease Clinical Clinical Trials Comorbidity Congestive Heart Failure Cross-Sectional Studies Data Development Diabetes Mellitus Disease Disease Progression Ecological momentary assessment Evaluation Expectancy Foundations Frequencies Future Goals Health Health Care Costs Health behavior Health system High Prevalence Hospitals Hypertension Impaired cognition Impairment Individual Informal Social Control Intervention Knowledge Link Longitudinal Studies Lung diseases Measures Mediating Medical Monitor Outcome Participant Patient Self-Report Patient-Focused Outcomes Patients Pharmaceutical Preparations Pharmacotherapy Pharmacy facility Population Population Intervention Public Health Quality of life Reaction Records Recruitment Activity Reporting Research Respiratory Signs and Symptoms Respiratory physiology Sampling Self Efficacy Self Management Symptoms System Time Treatment Protocols United States Centers for Medicare and Medicaid Services Visit base burden of illness cognitive function depressive symptoms disability effective intervention experience functional status health belief health literacy hospital readmission improved innovation medication compliance novel programs psychologic public health relevance reduce symptoms respiratory symptom management theories therapy development

项目摘要

DESCRIPTION (provided by applicant): COPD is the third leading cause of death and the leading cause of disability in the US. Despite the growing availability of efficacious pharmacotherapy for COPD, patients still experience a significant disease burden and with more than half reporting significant impairment in functioning. Thus the efficacy of COPD medications in clinical trials stands in stark contrast to the poor outcomes experienced by patients in the real world. One possible explanation for this gap is low rates of medication adherence. Only 25% of COPD patients are adherent, which is the lower than other chronic illnesses including diabetes, hypertension and congestive heart failure. Despite the high prevalence of nonadherence in COPD interventions there are significant gaps in the development and evaluation of interventions for adherence. Previous research has been based on cross sectional studies using self-reported measures of adherence and largely a theoretical. In the absence of data, many hospital systems are developing interventions to address medication adherence as part of their clinical program to reduce hospital readmissions and avoid financial penalties from CMS. This project proposes to recruit 360 patients with COPD to longitudinally evaluate potential determinants on adherence and disease progression based on theory of self-regulation. Participants will use novel electronic medication monitors to measure adherence to long term controller and rescue medications and ecological momentary assessments to measure patient reported respiratory symptoms and patients reactions including outcome expectancies, self-efficacy to management symptoms and medication health beliefs. This data will be used to evaluate the theory of self-regulation in COPD. Participants will also complete bi-annual clinical visits to track disease progression on clinical outcomes (e.g., lung function, functional status, quality of life) and psychological/ cognitive functioning. The impact f this study is to identify novel and potentially powerful targets for behavioral interventions in COPD which has been understudied despite its tremendous detrimental impact on overall public health.

描述（由申请人提供）：慢性阻塞性肺病是美国第三大死亡原因和导致残疾的主要原因，尽管针对慢性阻塞性肺病的有效药物治疗越来越多，但患者仍然承受着严重的疾病负担，并且超过一半的患者报告有明显的损伤。因此，慢性阻塞性肺病药物在临床试验中的疗效与现实世界中患者所经历的不良结果形成鲜明对比，这种差距的一个可能解释是只有 25% 的慢性阻塞性肺病患者坚持用药。哪个尽管慢性阻塞性肺病干预措施的不依从性很高，但先前的研究是基于使用自我的横断面研究，但在制定和评估依从性方面仍存在显着差距。 - 报告的依从性测量，很大程度上是理论性的。由于缺乏数据，许多医院系统正在制定干预措施来解决药物依从性问题，作为其临床计划的一部分，以减少再入院并避免 CMS 的经济处罚。患有慢性阻塞性肺病根据自我调节理论，纵向评估依从性和疾病进展的潜在决定因素，参与者将使用新型电子药物监测仪来测量对长期控制器和救援药物的依从性，并使用生态瞬时来测量患者报告的呼吸道症状和患者反应（包括结果）。这些数据将用于评估慢性阻塞性肺病的自我调节理论，以跟踪临床结果的疾病进展（例如肺功能）。、功能状态、质量这项研究的影响是确定 COPD 行为干预的新颖且潜在强大的目标，尽管它对整体公共卫生产生巨大的痛苦影响，但尚未得到充分研究。