Multifaceted Prospective Memory Intervention to Improve Medication Adherence

多方面的前瞻性记忆干预可提高药物依从性

• 批准号: 7695022
• 负责人: KATHLEEN C INSEL
• 金额: $ 43.8万
• 依托单位: UNIVERSITY OF ARIZONA
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-30 至 2012-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7695022
• 关键词: Address; Adherence; Adult; Age; Age-Years; Antihypertensive Agents; Applied Research; Area; Behavior; Blood Pressure; Cardiovascular system; Cerebrovascular Disorders; Cessation of life; Chronic; Chronic Disease; Cognitive; Communities; Control Groups; Cues; Dependence; Development; Disease; Dose; Education; Effectiveness; Elderly; Electronics; Environment; Event; Health Care Costs; Heart failure; Home environment; Hypertension; Hypotension; Impaired cognition; Individual; Intention; Intervention; Investigation; Laboratories; Measures; Medical; Medicine; Memory; Monitor; Patients; Pattern; Performance; Pharmaceutical Preparations; Phase; Population; Procedures; Process; Psychological reinforcement; Public Health; Quality of life; Randomized; Research; Resources; Risk; Risk Reduction; Short-Term Memory; Societies; Stroke; Testing; Time; Training; Visit; age related; base; blood pressure regulation; comparison group; cost; design; disability; executive function; experience; group intervention; human old age (65+); hypertension control; improved; innovation; medication compliance; modifiable risk; prevent; prospective; prospective memory; public health relevance; systematic review; task analysis

DESCRIPTION (provided by applicant): Adherence to medication is the single most important strategy to prevent high blood pressure and its subsequent deleterious and costly effects including stroke, heart failure and cognitive decline. Adherence is a significant problem in hypertension with estimates of only 50 percent appropriately adhering to their prescribed medications. Hypertension is also an asymptomatic chronic illness and therefore one without internal memory cues to medication taking. Hypertension is prevalent among older adults who have been shown to experience declines in cognitive processes that otherwise might compensate for the lack of internal cues to support adherence. The purpose of the proposed study is to test the effect of an in-home, tailored, multifaceted prospective memory intervention on adherence to antihypertensive medication for adults 65 years of age and older. The intervention is grounded in recent empirical and theoretical developments in the area of prospective memory and focuses on enhancing medication adherence through the use of relatively well-preserved cue- driven and automatic processes. Older adults who are self-managing at least one antihypertensive agent and are adherent to this medication less than or equal to 90 percent following 4 weeks of baseline monitoring, will be randomly assigned to one of two groups. One group will receive the intervention consisting of 4 phases: establishing a relationship, education, implementation of multifaceted strategies to improve prospective remembering and weekly reinforcement sessions for 3 weeks. The education comparison group will only receive part of the first and second phase of the intervention, establishing a relationship and education and will be visited for an additional 3 weeks similar to the visits for the intervention group, but will not receive strategy training. Adherence will be determined using Medication Electronic Monitoring. It is hypothesized that the intervention group will have greater overall adherence and that the relationship between overall adherence and executive function/working memory will be smaller than for the education comparison group because the intervention reduces the need for high levels of executive function to achieve adherence. Patterns of adherence will be assessed across a six-month period. A major public health consequence of this study is limiting disabilities among older adults because hypertension is associated with cognitive decline and cardiovascular and cerebrovascular disease including stroke. While this intervention is being tested with older adults, the intervention has broad implications for improving adherence in other populations. PUBLIC HEALTH RELEVANCE: Taking medications as prescribed is the single most important way to prevent the effects of high blood pressure. This study addresses the important public health problem of high blood pressure by testing an intervention to help people take medications as prescribed. If we can improve the way people take blood pressure medicines, we can improve the quality of life for older adults and decrease health care costs.

描述（由申请人提供）：坚持用药是预防高血压及其随后的有害且代价高昂的影响（包括中风、心力衰竭和认知能力下降）的最重要策略。依从性是高血压患者的一个重要问题，估计只有 50% 的人能够适当地遵守处方药物。高血压也是一种无症状的慢性疾病，因此没有内部记忆提示服用药物。高血压在老年人中普遍存在，事实证明，他们的认知过程会下降，否则可能会弥补支持依从性的内部线索的缺乏。拟议研究的目的是测试家庭、定制、多方面的前瞻性记忆干预对 65 岁及以上成年人坚持抗高血压药物的影响。该干预措施以前瞻性记忆领域最近的经验和理论发展为基础，重点是通过使用保存相对完好的线索驱动和自动过程来提高药物依从性。自我管理至少一种抗高血压药物并且在 4 周基线监测后坚持使用该药物的比例低于或等于 90% 的老年人将被随机分配到两组中的一组。一组将接受由 4 个阶段组成的干预：建立关系、教育、实施多方面策略以改善前瞻性记忆以及每周强化课程，持续 3 周。教育对照组将仅接受第一阶段和第二阶段干预的部分内容，建立关系和教育，并将与干预组的访问类似，进行额外的 3 周访问，但不会接受策略培训。将使用药物电子监测来确定依从性。假设干预组将具有更高的总体依从性，并且总体依从性与执行功能/工作记忆之间的关系将小于教育对照组，因为干预减少了实现依从性所需的高水平执行功能。将在六个月内评估依从模式。这项研究的一个主要公共卫生后果是限制老年人的残疾，因为高血压与认知能力下降和包括中风在内的心脑血管疾病有关。虽然这种干预措施正在老年人中进行测试，但该干预措施对于提高其他人群的依从性具有广泛的影响。公共卫生相关性：按处方服用药物是预防高血压影响的最重要的方法。这项研究通过测试帮助人们按处方服药的干预措施来解决高血压这一重要的公共卫生问题。如果我们能够改善人们服用血压药物的方式，我们就可以改善老年人的生活质量并降低医疗保健成本。