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Theme Three: Promoting and Maintaining Disease Self-Management

Improving Adherence and Intensification of Medications

Background

For patients with diabetes, hypertension, high cholesterol and other chronic health problems, medication therapy is a cornerstone of effective treatment.

Medication adherence problems are common and lead to preventable complications, hospitalizations, disability and death. Even when patients take their medication as prescribed, many fail to reach the desired outcome because their medication regimen is not sufficiently intense.

Addressing these problems is extremely difficult because both patients and their health care teams are often unable to identify episodes of inadequate medication adherence, inappropriate dosing, or barriers to improving medication use.

Service Innovation: Translational Intervention

QUICCC investigators are developing a translational intervention that combines tailored adherence counseling with medication management focused on identifying appropriate drugs and doses delivered by a clinical pharmacist.

The model is being developed using the Department of Veterans Affairs’ extensive electronic medical records, including comprehensive information about medication filling and patients’ progress.

Clinical pharmacists receive reports that characterize patients’ adherence history and medication intensification, and use those reports to identify appropriate follow-up.

Ongoing  research and development

QUICCC investigators were awarded funding from both the  National VA Health Services Research and Development Program and the National Institutes of Health to evaluate the impact of this new service on diabetes patients’ blood pressure, glycemic control and cholesterol levels.

The Adherence and Intensification of Medicines study is a cluster randomized clinical trial that will examine improvements in risk factor control for patients at three VA sites in ten primary care teams.

In addition, QUICCC investigators have submitted a National Institutes of Health proposal to do a similar intervention at Kaiser Northern California, as well as a Clinical and Translational Science Award proposal to implement the service for patients in community and UMHS clinics.

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Promoting Physical Activity with Low-Cost Interventions

Background

Physical activity can address many of the problems that chronically ill older adults face by:

Unfortunately, promoting physical activity within clinic settings has been either ineffective or too difficult to apply in the real-world.

Pedometers can help patients increase how much they walk by providing objective feedback on their activity levels but pedometer use is extremely difficult for a patient’s health care team to oversee. Some clinicians are even concerned that encouraging their patients to walk may increase their risk for future health problems.

Service Innovation: Stepping Up to Health

Stepping Up to Health is an Internet-based program that promotes walking in people who have or who are at risk for chronic diseases.

Participants wear an enhanced pedometer that records the number of steps they’ve taken and can be connected to a personal computer with Internet access. The step-count data can then be automatically uploaded to the Stepping Up to Health Web site where participants receive detailed graphs of their daily walking activity

Ongoing research and development

QUICCC investigators are conducting several studies evaluating the effectiveness of using advanced pedometers as a tool for promoting physical activity among chronically-ill patients.

The Veterans Walk for Health Study is a multi-center, randomized controlled trial investigating the effectiveness of two different modes of pedometer step-count feedback on walking behavior.

VA patients with risk factors for cardiovascular disease who have been referred by a physician for nutritional counseling are being enrolled from five sites nationally.

The Veterans Walk to Beat Back Pain Study will evaluate the impact of a pedometer-based intervention to promote walking and improve pain-related function among patients with chronic back pain. 

Patients randomized into the intervention group are given an enhanced pedometer and have access to a website providing step goals and feedback, as well as tailored motivationa messages.

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