Optimizing Testosterone Prescribing in the VA

优化退伍军人事务部的睾酮处方

基本信息

项目摘要

 DESCRIPTION (provided by applicant): This is the second submission of a VA HSR&D CDA proposal to provide five years of salary support to Guneet K. Jasuja, PhD toward her goal of becoming a VA independent investigator and expert on medication prescribing research. Dr. Jasuja is a research health scientist in the HSR&D Center for Healthcare Organization and Implementation Research (CHOIR). This proposal delineates the research and training objectives that will lead to Dr. Jasuja's maturation into an independent health services researcher while contributing to the quality of care for Veterans. The first aim is to elucidate quantitative patient-, provider-, and site-level predictor of potentially inappropriate testosterone prescribing that to date have not been explored. Analyses will be conducted using administrative data on all male Veteran patients without HIV, who had at least one outpatient visit and one prescription fill during FY08-FY14. We will apply Generalized Linear Mixed Models to examine our putative predictors at the patient- (e.g. depression), provider- (e.g. older age) and site-level (e.g. academic affiliation). The second aim is to examine patient, provider, and key opinion leader perceptions and system-level factors that relate to testosterone prescribing, using qualitative methods. For this study, we will conduct semi- structured interviews with patients, providers, and site-level thought leaders to gain additional insight into how their perceptions, as well as site factors, may influence testosterone prescribing. To effect meaningful change in prescribing, the results of the first two research aims will be combined with relevant findings in the literature to develop and pilot test a multi-faceted intervention to promote appropriate use of testosterone in the VA. The research proposed here will improve quality of care by limiting testosterone therapy to those patients most likely to benefit and least likely to be harmed. Investigating the context of testosterone prescribing and factors that contribute to suboptimal prescribing practices would be an important preparatory step before designing and implementing interventions to optimize testosterone therapy for those men in whom it is medically indicated. Findings from these studies will yield heretofore unknown information about several key aspects of potentially inappropriate testosterone prescribing, enabling future HSR&D research proposals to address similar medication prescribing issues. Lessons learnt from this study will also serve as an exemplar for other medications, which embody similar characteristics, including high cost and potential safety issues. In conjunction with the proposed research aims, the CDA will address key training objectives that will further develop Dr. Jasuja's research capabilities. These training objectives will provide formal and hands-on education in qualitative and implementation research methods. The carefully chosen mentorship team, selected for their knowledge and experience in the methodologies and content areas addressed in the proposal, is dedicated to fostering Dr. Jasuja's successful transition to an independent investigator. Drs. Rose and Bhasin have an established working relationship as current mentors on Dr. Jasuja's VISN 1 CDA, and Drs. Bokhour and Gifford have provided guidance and advice for several years. All are committed to the career development of Dr. Jasuja and the need for protected research time, as described in their attached letters. CHOIR has also committed resources to accomplish the objectives in the proposal. Dr. Jasuja's initial contribution will be to understand the factors that contribute to variation and overuse in testosterone across VA. In the long term, she will apply these skills more generally to the issue of reducing variation and overuse in other areas of care. The long-term outcome will be significant improvements in safe, effective, and high-quality medication prescribing to reduce adverse outcomes for Veterans.
 描述(由申请人提供): 这是退伍军人事务部HSR&D CDA第二次提交提案,为Guneet K.Jasuja博士提供五年的工资支持,以实现她成为退伍军人事务部独立调查员和药物处方研究专家的目标。Jasuja博士是HSR&D医疗保健组织和实施研究中心(合唱团)的研究健康科学家。该提案勾勒出了研究和培训目标,这些目标将导致Jasuja博士成熟为一名独立的保健服务研究员,同时有助于提高对退伍军人的护理质量。第一个目的是阐明到目前为止还没有探索过的潜在不适当睾丸素处方的患者、提供者和部位水平的定量预测因素。分析将使用所有未感染艾滋病毒的男性退伍军人患者的管理数据进行,他们在08财年至2014财年期间至少有一次门诊就诊和一次处方填写。我们将应用广义线性混合模型来检验我们在患者(例如抑郁症)、提供者(例如年龄较大)和地点层面(例如学术背景)的假定预测因素。第二个目标是检查 患者、提供者和关键意见领袖的看法,以及与睾酮处方有关的系统级因素,使用定性方法。在这项研究中,我们将对患者、提供者和站点级别的思想领袖进行半结构化访谈,以进一步了解他们的看法以及站点因素可能如何影响睾酮处方。为了在处方上产生有意义的变化,前两项研究的结果 将结合文献中的相关发现来开发和试运行多方面的 促进退伍军人管理局合理使用睾酮的干预措施。这里提出的这项研究将通过将睾酮治疗限制在最有可能受益和最不可能受到伤害的患者来提高护理质量。调查睾酮处方的背景和导致不太理想的处方做法的因素,将是在设计和实施干预措施之前的重要准备步骤,以优化那些医学上表明的男性的睾酮治疗。这些研究的结果将产生迄今为止未知的关于可能不适当的睾酮处方的几个关键方面的信息,使未来的HSR&D研究提案能够解决类似的药物处方问题。从这项研究中吸取的经验教训也将作为其他药物的典范,这些药物具有类似的特点,包括高昂的成本和潜在的安全问题。与拟议的研究目标相结合,CDA将解决关键的培训目标,这些目标将进一步发展Jasuja博士的研究能力。这些培训目标将提供质量和实施研究方法方面的正式和实践教育。精心挑选的指导团队是根据他们在提案中涉及的方法和内容领域的知识和经验而选择的,致力于促进Jasuja博士成功地过渡到一名独立的调查员。Rose博士和Bhasin博士作为Jasuja博士的VISN 1 CDA的现任导师建立了良好的工作关系,而Bokhr博士和Gifford博士多年来一直提供指导和建议。所有人都致力于Jasuja博士的职业发展和保护研究时间的需要,如他们所附信件中所述。合唱团还承诺投入资源来实现提案中的目标。Jasuja博士最初的贡献将是了解导致退伍军人事务部睾丸素变异和过度使用的因素。从长远来看,她将更广泛地将这些技能应用于减少变异和在其他护理领域过度使用的问题。长期结果将是安全、有效和高质量的药物处方显著改善,以减少退伍军人的不良后果。

项目成果

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Guneet Jasuja其他文献

Guneet Jasuja的其他文献

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{{ truncateString('Guneet Jasuja', 18)}}的其他基金

Optimizing Testosterone Prescribing in the VA
优化退伍军人事务部的睾酮处方
  • 批准号:
    10308544
  • 财政年份:
    2016
  • 资助金额:
    --
  • 项目类别:

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