Optimization of hyperlipidemia management among patients with rheumatoid arthritis: A patient-centered intervention development

项目概要 风湿病学最伟大的成功故事之一 - 类风湿性关节炎 (RA) 缓解 - 由于 RA 患者的评估和治疗严重不足，以减少 心血管疾病（CVD）风险。该项目将为测试干预措施奠定基础 假设我将开发针对 RA 人群的以患者为中心的干预措施 K23 的一部分将改善 RA 的高脂血症筛查和治疗，从而降低 CVD 风险。 对于 K23 和未来的项目，我们将以阿拉巴马大学伯明翰分校 (UAB) 的基础为基础 与以患者为中心的结果研究所 (PCORI) 资助的 ArthritisPower Patient 合作 动力研究网络（PPRN）。我们将与 ArthritisPower >2,000 RA 的成员合作 美国所有 50 个州的患者和护理人员。在这个提案中，我们将开发并测试一种新颖的可行性 理论驱动（使用班杜拉的社会认知理论），以患者为中心的教育决策支持/同伴 教练干预，从而掌握制定和实施患者治疗的基本技能 从事干预研究。该提案的目的是： 目标 1：确定患者和医生降低 RA CVD 风险的障碍。在此目标期间，我们将申请 定性方法来引发有关 CVD 和降低 CVD 风险的态度、信念和障碍。 目标 2：开发一种旨在优化 RA 患者血脂筛查和管理的干预措施。我们 将根据目标 1 中收集的数据制定干预措施。这将包括患者教育和 决策支持计划，以促进高脂血症筛查或开始降脂治疗 (LLT) （主要结果）以及采取降脂治疗和患者激活的自我效能（次要结果）。 目标 3：对目标 2 中开发的干预措施进行试点测试。在此目标期间，我们将应用以下相关方法 临床试验来测试新开发的干预措施的可行性。 这项研究将导致以患者为中心的干预措施，以促进解决差距所需的第一步 RA 中高脂血症的筛查和治疗。长期目标包括发展 基金会与以下机构合作对该干预措施（以及未来的研究）进行务实试验 关节炎力量。我们将纳入其他可改变的 CVD 危险因素，例如高血压，不仅针对 RA 患者，但也面临其他风湿病和风湿病学中其他令人烦恼的挑战，例如 药物/治疗依从性。

Project Summary One of the greatest success stories in rheumatology - the achievement of rheumatoid arthritis (RA) remission - is tempered by the fact that individuals with RA are dramatically under evaluated and under treated to reduce cardiovascular disease (CVD) risk. This project will build the foundation for an intervention that will test the hypothesis that the patient-centered intervention tailored to the RA population that I will develop as part of this K23 will improve hyperlipidemia screening and treatment in RA, thereby reducing CVD risk. For the K23 and future projects, we will build on the University of Alabama at Birmingham (UAB)'s collaboration with the Patient-Centered Outcomes Research Institute (PCORI)-funded ArthritisPower Patient Powered Research Network (PPRN). We will work in partnership with members of ArthritisPower >2,000 RA patients and caregivers in all 50 US states. In this proposal, we will develop and test the feasibility of a novel theory-driven (Using Bandura's Social Cognitive Theory), patient-centered educational decision support/peer coaching intervention, thereby mastering foundational skills in the development and implementation of patient- engaged intervention research. The aims of this proposal are: Aim 1: To identify patient and physician barriers to CVD risk reduction in RA. During this aim, we will apply qualitative methods to elicit attitudes, beliefs and barriers regarding CVD and CVD risk reduction. Aim 2: To develop an intervention designed to optimize lipid screening and management in RA patients. We will build the intervention based on the data collected in Aim 1. This will consist of patient education and a decision support program to facilitate screening for hyperlipidemia or initiation of lipid lowering therapy (LLT) (primary outcome) and self-efficacy in taking lipid lowering therapy and patient activation (secondary outcome). Aim 3: To pilot test the intervention developed in Aim 2. During this aim, we will apply methods related to clinical trials to test the feasibility of the newly developed intervention. This study will result in a patient-centered intervention to facilitate the first steps needed to address the gap in screening and management of hyperlipidemia in RA. The long term goals include the development of a foundation to conduct a pragmatic trial of this intervention (and future studies) in collaboration with ArthritisPower. We will incorporate other modifiable CVD risk factors such as hypertension not only targeted to RA patients but to other rheumatic diseases and other vexing challenges in rheumatology such as medication/treatment adherence.