Telehealth Enhancement of Adherence to Medication in Pediatric IBD (TEAM Study)

远程医疗增强儿童 IBD 的药物依从性（TEAM 研究）

• 批准号: 8898159
• 负责人: Kevin Hommel
• 金额: $ 43.01万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-08-01 至 2017-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8898159
• 关键词: 18 year old; Adherence; Adolescent; Affect; Aftercare; Behavior; Behavior Control; Behavior Therapy; Child; Childhood; Chronic; Clinical; Clinical Trials; Complex; Data; Diagnosis; Disease Management; Education; Enrollment; Family; Funding; Goals; Health; Health Care Costs; Health Services Accessibility; Healthcare; Home environment; Individual; Inflammatory Bowel Diseases; Intervention; Knowledge; Medical; Methods; Modeling; Outcome; Outcome Study; Parents; Participant; Patients; Pharmaceutical Preparations; Population; Prevalence; Problem behavior; Provider; Public Health; Randomized Controlled Clinical Trials; Relapse; Research; Resources; Risk; Sampling; Severity of illness; Subgroup; Testing; Time; Training; Treatment Protocols; Treatment outcome; United States National Institutes of Health; Visit; abstracting; base; behavioral health; clinically relevant; clinically significant; cost; cost effectiveness; economic impact; efficacy testing; evidence base; follow-up; health care service utilization; health economics; health related quality of life; improved; individualized medicine; innovation; medication compliance; meetings; novel; targeted treatment; telehealth; treatment center; treatment effect

DESCRIPTION (provided by applicant): Project Summary/Abstract Research on medication adherence in pediatric inflammatory bowel disease (IBD) has demonstrated nonadherence rates ranging from 50-88 percent across medications. These data are alarming given that 1) the risk of relapse in IBD is 5.5 times greater in nonadherent patients than in adherent patients, 2) the annual costs of health care in nonadherent IBD patients are 12.5 percent higher, and 3) the estimated annual cost of nonadherence in US health care is $100-300 billion. Factors related to poor adherence include deficits in knowledge about IBD and medications used for treatment, organizational barriers, and behavioral problems in adolescents and/or their families. Thus, nonadherence is a complex and significant health care issue in IBD, requiring effective multicomponent behavioral intervention to improve treatment outcomes. Our current treatment outcome studies demonstrate the feasibility and preliminary efficacy of family based behavioral intervention for nonadherence. This intervention is viewed favorably by patients and families, and retention is high. Individually-tailored behavioral treatments are advantageous because of their ability to analyze and target specific behaviors that functionally maintain nonadherence, which vary across patients. However, only a limited subgroup of patients is able to receive this type of treatment due to a lack of available trained providers and/or distance between patient homes and their treatment facility, making it prohibitive to attend the necessary weekly treatment sessions. Telehealth delivery of behavioral intervention has been used successfully in pediatric populations, but has not targeted treatment adherence promotion. Determining the most optimal method of treatment delivery to the most patients who would benefit from it is a critical next step in this line of research. Thus, the proposed study aims to test, via a randomized controlled clinical trial, the efficacy of a novel telehealth behavioral treatment (TBT) protocol to improve medication adherence, disease severity, health-related quality of life, and health care utilization in children and adolescents with IBD. Participants in the TBT condition will be compared to those in an education only (EO) condition. In addition to using a novel telehealth approach to delivery of an individually-tailored behavioral treatment for nonadherence in underserved IBD patients, this study will target a clinically relevant sample of patients who demonstrate substantial nonadherence that might affect health outcomes. The proposed study may have a significant impact on public health by providing an evidence base for individually-tailored behavioral treatment of nonadherence delivered in a manner that reduces health care disparities for families that have limited access to services. One hundred ninety-four patients (11-18 years of age) and their parents will be enrolled in the study. Given the prevalence of nonadherence in IBD and its health and economic impact, this study is timely and important, as it has the potential to optimize behavioral treatment of nonadherence, positively impact IBD health outcomes, and serve as a model for adherence intervention in other pediatric populations.

描述（由申请人提供）：项目摘要/摘要 关于儿科炎症性肠病 (IBD) 药物依从性的研究表明，各种药物的不依从率在 50-88% 之间。这些数据令人震惊，因为 1) 不依从性 IBD 患者的 IBD 复发风险是依从性患者的 5.5 倍，2) 不依从性 IBD 患者的年度医疗费用高出 12.5%，以及 3) 估计的年度费用美国医疗保健不遵守的金额高达 100-3000 亿美元。与依从性差相关的因素包括对 IBD 和治疗药物的了解不足、组织障碍以及青少年和/或其家庭的行为问题。因此，不依从​​性是 IBD 中一个复杂而重要的医疗保健问题，需要有效的多成分行为干预来改善治疗结果。我们目前的治疗结果研究证明了基于家庭的行为干预治疗不依从性的可行性和初步疗效。这种干预措施受到患者和家属的好评，并且保留率很高。个性化定制的行为治疗是有利的，因为它们能够分析和针对功能上维持不依从性的特定行为，而这些行为因患者而异。然而，由于缺乏训练有素的提供者和/或患者家与治疗机构之间的距离，只有有限的患者亚组能够接受这种类型的治疗，从而无法参加必要的每周治疗课程。行为干预的远程医疗服务已成功应用于儿科人群，但并未有针对性地促进治疗依从性。确定为大多数可从中受益的患者提供最佳治疗方法是这一研究领域的关键下一步。因此，拟议的研究旨在通过随机对照临床试验来测试新型远程医疗行为治疗（TBT）方案的有效性，以提高儿童和儿童的药物依从性、疾病严重程度、健康相关的生活质量以及医疗保健利用率。患有 IBD 的青少年。 TBT 条件下的参与者将与纯教育 (EO) 条件下的参与者进行比较。除了使用新颖的远程医疗方法为服务不足的 IBD 患者的不依从性提供个性化的行为治疗外，这项研究还将针对临床相关的患者样本，这些患者表现出严重的不依从性，可能会影响健康结果。拟议的研究可能会对公共健康产生重大影响，因为它为针对不依从性的个体定制行为治疗提供了证据基础，以减少获得服务机会有限的家庭的医疗保健差距。一百九十四名患者（11-18 岁）及其父母将参加该研究。鉴于 IBD 不依从性的普遍性及其对健康和经济的影响，这项研究是及时且重要的，因为它有可能优化不依从性的行为治疗，对 IBD 健康结果产生积极影响，并作为其他儿科依从性干预的模型人口。

项目成果

Targeting Health Behaviors to Reduce Health Care Costs in Pediatric Psychology: Descriptive Review and Recommendations.

针对健康行为以降低儿科心理学的医疗保健成本：描述性审查和建议。

• 发表时间: 2016-09
• 影响因子: 3.6
• 作者: McGrady, Meghan E;Hommel, Kevin A
• 通讯作者: Hommel, Kevin A

The clinical utility of health-related quality of life screening in a pediatric inflammatory bowel disease clinic.

儿科炎症性肠病诊所中健康相关生活质量筛查的临床效用。

• 发表时间: 2013-11
• 影响因子: 4.9
• 作者: Ryan, Jamie L;Mellon, Michael W;Junger, Katherine W F;Hente, Elizabeth A;Denson, Lee A;Saeed, Shehzad A;Hommel, Kevin A
• 通讯作者: Hommel, Kevin A