{"id":489,"date":"2012-01-22T15:19:24","date_gmt":"2012-01-22T06:19:24","guid":{"rendered":"http:\/\/www.hcfm.jp\/journal\/?p=489"},"modified":"2015-08-06T15:21:08","modified_gmt":"2015-08-06T06:21:08","slug":"%e3%81%86%e3%81%a4%e7%97%85%e6%82%a3%e8%80%85%e3%81%ae%e7%94%9f%e6%b4%bb%e7%bf%92%e6%85%a3%e7%97%85%e3%81%ae%e7%ae%a1%e7%90%86","status":"publish","type":"post","link":"https:\/\/www.hcfm.jp\/journal\/?p=489","title":{"rendered":"\u3046\u3064\u75c5\u60a3\u8005\u306e\u751f\u6d3b\u7fd2\u6163\u75c5\u306e\u7ba1\u7406"},"content":{"rendered":"<p>\u3010\u6587\u732e\u540d\u3011<\/p>\n<p>Treatment Adjustment and Medication Adherence for Complex Patients With Diabetes, Heart Disease, and Depression: A Randomized Controlled Trial. Ann Fam Med 2012;10:6-14.<\/p>\n<p>\u3010\u8981\u7d04\u3011<\/p>\n<p>\uff1cPURPOSE\uff1e<br \/>\n\u00a0Medication nonadherence, inconsistent patient self-monitoring, and inadequate treatment adjustment exacerbate poor disease control. In a collaborative, team-based, care management program for complex patients (TEAMcare), we assessed patient and physician behaviors (medication adherence, self-monitoring, and treatment adjustment) in achieving better outcomes for diabetes, coronary heart disease, and depression.<\/p>\n<p>\uff1cMETHODS\uff1e<br \/>\n\u00a0A randomized controlled trial was conducted (2007-2009) in 14 primary care clinics among 214 patients with poorly controlled diabetes (glycated hemoglobin [HbA1c] \u22658.5%) or coronary heart disease (blood pressure >140\/90 mm Hg or low-density lipoprotein cholesterol >130 mg\/dL) with coexisting depression (Patient Health Questionnaire-9 score \u226510). In the TEAMcare program, a nurse care manager collaborated closely with primary care physicians, patients, and consultants to deliver a treat-to-target approach across multiple conditions. Measures included medication initiation, adjustment, adherence, and disease self-monitoring.<\/p>\n<p><a href=\"https:\/\/www.hcfm.jp\/journal\/wp-content\/uploads\/2015\/08\/120122_1.jpg\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.hcfm.jp\/journal\/wp-content\/uploads\/2015\/08\/120122_1.jpg\" alt=\"120122_1\" width=\"592\" height=\"399\" class=\"alignnone size-full wp-image-490\" srcset=\"https:\/\/www.hcfm.jp\/journal\/wp-content\/uploads\/2015\/08\/120122_1.jpg 592w, https:\/\/www.hcfm.jp\/journal\/wp-content\/uploads\/2015\/08\/120122_1-300x202.jpg 300w\" sizes=\"auto, (max-width: 592px) 100vw, 592px\" \/><\/a><\/p>\n<p>\uff1cRESULTS\uff1e<br \/>\n\u00a0Pharmacotherapy initiation and adjustment rates were sixfold higher for antidepressants (relative rate RR=6.20; P<.001), threefold higher for insulin (RR = 2.97; P <.001), and nearly twofold higher for antihypertensive medications (RR=1.86, P<.001) among TEAMcare relative to usual care patients. Medication adherence did not differ between the 2 groups in any of the 5 therapeutic classes examined at 12 months. TEAMcare patients monitored blood pressure (RR = 3.20; P <.001) and glucose more frequently (RR = 1.28; P = .006).\n\n<a href=\"https:\/\/www.hcfm.jp\/journal\/wp-content\/uploads\/2015\/08\/120122_2.jpg\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.hcfm.jp\/journal\/wp-content\/uploads\/2015\/08\/120122_2.jpg\" alt=\"120122_2\" width=\"511\" height=\"261\" class=\"alignnone size-full wp-image-491\" srcset=\"https:\/\/www.hcfm.jp\/journal\/wp-content\/uploads\/2015\/08\/120122_2.jpg 511w, https:\/\/www.hcfm.jp\/journal\/wp-content\/uploads\/2015\/08\/120122_2-300x153.jpg 300w\" sizes=\"auto, (max-width: 511px) 100vw, 511px\" \/><\/a><\/p>\n<p><a href=\"https:\/\/www.hcfm.jp\/journal\/wp-content\/uploads\/2015\/08\/120122_3.jpg\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.hcfm.jp\/journal\/wp-content\/uploads\/2015\/08\/120122_3.jpg\" alt=\"120122_3\" width=\"667\" height=\"277\" class=\"alignnone size-full wp-image-492\" srcset=\"https:\/\/www.hcfm.jp\/journal\/wp-content\/uploads\/2015\/08\/120122_3.jpg 667w, https:\/\/www.hcfm.jp\/journal\/wp-content\/uploads\/2015\/08\/120122_3-300x125.jpg 300w\" sizes=\"auto, (max-width: 667px) 100vw, 667px\" \/><\/a><\/p>\n<p>\uff1cCONCLUSIONS\uff1e<br \/>\n\u00a0Frequent and timely treatment adjustment by primary care physicians, along with increased patient self-monitoring, improved control of diabetes, depression, and heart disease, with no change in medication adherence rates. High baseline adherence rates may have exerted a ceiling effect on potential improvements in medication adherence.<\/p>\n<p>\u3010\u958b\u50ac\u65e5\u3011<\/p>\n<p>\uff12\uff10\uff11\uff12\u5e74\uff11\u6708\uff11\uff18\u65e5<\/p>\n","protected":false},"excerpt":{"rendered":"<p>\u3010\u6587\u732e\u540d\u3011 Treatment Adjustment and Medication Adherence for Complex Patients With Diabetes, Heart Disease, and Dep &hellip; <a href=\"https:\/\/www.hcfm.jp\/journal\/?p=489\" class=\"more-link\">\u7d9a\u304d\u3092\u8aad\u3080 <span class=\"screen-reader-text\">\u3046\u3064\u75c5\u60a3\u8005\u306e\u751f\u6d3b\u7fd2\u6163\u75c5\u306e\u7ba1\u7406<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[6],"tags":[],"class_list":["post-489","post","type-post","status-publish","format-standard","hentry","category-6"],"_links":{"self":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/489","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=489"}],"version-history":[{"count":1,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/489\/revisions"}],"predecessor-version":[{"id":493,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/489\/revisions\/493"}],"wp:attachment":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=489"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=489"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=489"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}