TeleHealth & Remote Measurement Technologies to Improve Med Adherence in HTN

远程医疗

• 批准号: 7937086
• 负责人: ROBERT H FRIEDMAN
• 金额: $ 49.95万
• 依托单位: BOSTON MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-30 至 2013-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7937086
• 关键词: Access to Information; Adherence; American; Antihypertensive Agents; Area; Behavior; Behavioral; Blood Pressure; Blood Pressure Monitors; Caring; Chronic Disease; Communication; Computers; Counseling; Data; Development; Disease Management; Economics; Electronic Health Record; Electronics; Equipment; Event; Health; Health system; Home environment; Hypertension; Intervention; Measurement; Measures; Mediating; Medical; Methods; Modeling; Modification; Monitor; Office Visits; Outcome; Patient Care; Patient Monitoring; Patient Noncompliance; Patient Self-Report; Patients; Perception; Pharmaceutical Preparations; Physicians; Prevention; Protocols documentation; Public Health; Randomized Clinical Trials; Recovery; Regimen; Relative (related person); Research; Research Project Grants; Science; Self Care; Series; Source; Surveys; System; Technology; Telecommunications; Testing; Time; arm; base; blood pressure regulation; compliance behavior; design; effective intervention; evidence base; improved; intervention effect; intervention program; medication compliance; new technology; programs; statistics; successful intervention; telehealth; theories; treatment as usual; trial comparing

DESCRIPTION (provided by applicant): Broad Challenge Area: 01: Behavior, Behavioral Change, and Prevention. Specific Challenge Topic: 06-OD(OBSSR)-101. Using new technologies to improve or measure adherence. At least half of the U.S.'s hypertension (HTN) patients are non- adherent to their prescribed anti-hypertensive medications which contributes to the appalling statistic that only 34% of Americans treated for HTN have controlled blood pressure (BP). Nonetheless, there is little being done in medical practice settings to improve adherence in HTN. We pioneered the use of telehealth technology in adherence promotion in medical practice settings. Our intervention was efficacious for improving adherence and BP control, but its effect was relatively small (effect size=.27). In this RC1 project, we will explore 2 significant technology-based modifications designed to increase the effect (using electronic measurement technology and electronic health system communication channels) to substantially enhance the effect of our telehealth program. In addition to potentially enhancing our intervention, the results will be transferable to other adherence promotion programs and should advance the science of adherence promotion. We plan to conduct a series of 3 studies in which the results or the first 2 will inform the design of the third. In study 1, we will evaluate alternative methods and protocols for measuring medication adherence and using the results to improve adherence via our telehealth program. In study 2, we will evaluate alternative strategies for delivering information and advice/decision support to physicians via their EHR for them to use during office visits to promote adherence and BP control. In study 3, we will combine the best methods and strategies from studies 1 & 2 and combine them with our original telehealth program. We will evaluate this enhanced program in a RCT with 152 non- adherent hypertension patients. We will determine the effect size of this study and compare it to our original study and other adherence promotion programs to judge its relative efficacy. We will look for expected behavioral mediating effects and effects of known moderators on intervention effects. The potential outcomes of this project are: (1) a more effective intervention, (2) more effective strategies to engage physicians in adherence promotion & medication regimen adjustment, and (3) understanding on how to use 3 technologies to promote adherence. Patients frequently do not take their medications as their physicians prescribe them, and this is a major contributor to suboptimal health outcomes for patients; for example, only one-third of hypertension patients under treatment have their blood pressure adequately controlled. We propose to utilize new technologies - 1) electronic monitoring of patient medication-taking and blood pressures, 2) computer-based telecommunications technologies for facilitating patient/physician communications, and 3) electronic health records systems - to help patients and their physicians deal with this problem. In this proposed project, we will develop a model medication improvement program and apply this program and study it in patients with hypertension, the most common chronic disease.

描述（申请人提供）：广泛的挑战领域：01：行为，行为改变和预防。具体挑战主题：06-OD（obssr）-101。使用新技术改善或衡量依从性。美国至少一半的高血压（HTN）患者不遵守其处方的抗高血压药物，这有助于令人震惊的统计数据，该统计数据只有34％接受HTN治疗的美国人受到控制的血压（BP）。尽管如此，医疗实践环境中几乎没有做任何事情来提高HTN的依从性。我们开创了在医疗实践环境中遵守远程医疗技术的使用。我们的干预措施有效地改善了依从性和BP控制，但其效果相对较小（效果尺寸= .27）。在此RC1项目中，我们将探索两种旨在提高效果的重要基于技术的修改（使用电子测量技术和电子卫生系统通信渠道），以实质上增强了我们的远程医疗计划的效果。除了潜在地增强我们的干预外，结果还可以转移到其他依从性促进计划中，并应提高依从性促进科学。我们计划进行一系列3项研究，其中结果或前2个将为第三项设计提供信息。在研究1中，我们将评估替代方法和方案，以测量药物依从性并利用结果来通过我们的远程医疗计划提高依从性。在研究2中，我们将评估通过其EHR向医生提供信息和建议/决策支持的替代策略，以便在办公室访问期间使用以促进依从性和BP控制。在研究3中，我们将结合研究1和2的最佳方法和策略，并将其与我们的原始远程医疗计划相结合。我们将在RCT中评估152名非依从性高血压患者的增强程序。我们将确定这项研究的效果大小，并将其与我们的原始研究和其他依从性促进计划进行比较，以判断其相对效果。我们将寻找已知主持人对干预效果的预期行为介导和影响。该项目的潜在结果是：（1）一种更有效的干预措施，（2）使医生参与依从性促进和药物调整的更有效策略，以及（3）了解如何使用3种技术来促进依从性。患者经常不会服用药物作为医生开处方，这是患者次优健康结果的主要贡献者。例如，只有三分之一的治疗高血压患者可以充分控制其血压。我们建议利用新技术-1）对患者药物治疗和血压的电子监测，2）基于计算机的电信技术，用于促进患者/医师的沟通，以及3）电子健康记录系统 - 以帮助患者及其医生解决此问题。在这个拟议的项目中，我们将制定一个模型药物改进计划，并应用该计划，并将其研究为高血压患者，这是最常见的慢性疾病。