VANDERBILT CENTER FOR EDUCATION/RESEARCH ON THERAPEUTICS

范德比尔特治疗教育和研究中心(CERT)被提议作为系统地促进合理药物治疗的国家合作的一部分。CERT将致力于系统地将科学进步转化为改善的临床结果。范德比尔特CERT的主题是鼓励医疗补助管理保健中的理性药物治疗。医疗补助人群是治疗的焦点，因为它的参与者特别容易受到次优药物治疗的影响，而且由于各种原因，在现有的研究中代表不足。弱势群体包括发育中的胎儿、幼儿、非裔美国人和其他少数群体、慢性病患者、老年人和养老院的人。医疗补助人口还提供了一个出色的数据来源，允许识别次优药物治疗和评估教育计划。我们对管理式医疗的关注强调，合理药物治疗的一个未被认识到的决定因素可能是由管理式医疗实施的计划和政策。Vanderbilt CERT的目标是通过对抗合理药物治疗的三个具体威胁来改善药物治疗：知识基础不足、次优提供者或患者行为以及适得其反的政策。为此，CERT将结合药物流行病学、卫生服务研究、临床药理学、信息学、生物统计学和行为科学的专业知识。因此，CERT的具体目的是：1.通过临床药理学和药物流行病学研究，完善合理药物治疗的知识库。我们提出了两项先导性研究，一项是影响药物在避难所渗透的因素，另一项是比较COX-1和COX-2非甾体抗炎药的不良反应。2.通过有重点的教育计划，改变不太理想的提供者或患者行为。3.通过对计划和政策变化进行严格评估，确定政策对药物治疗和临床结果的影响。

A Vanderbilt Center for Education and Research in Therapeutics (CERT) is proposed as part of a national collaboration to systematically promote rational pharmacotherapy. The CERTs will work to systematically translate scientific advances into improved clinical outcomes. The theme of the Vanderbilt CERT is Encouraging Rational Pharmacotherapy in Medicaid Managed Care. The Medicaid population is the therapeutic focus because its enrollees are particularly vulnerable to suboptimal pharmacotherapy and that, for a variety of reasons, are underrepresented in extant research. Vulnerable groups include he developing fetus, young children, African-Americans and other minorities, the chronically ill, the elderly, and persons in nursing homes. The Medicaid population also provides an outstanding data source that permits identification of suboptimal pharmacotherapy and evaluation of educational programs. Our focus on managed care emphasizes that an under-recognized determinant of rational pharmacotherapy may be programs and policies implemented by managed care. The goal of the Vanderbilt CERT is to improve pharmacotherapy by combatting three specific threats to rational pharmacotherapy: inadequate knowledge base, suboptimal provider or patient behavior, and counterproductive policies. To this end, the CERT will combine expertise in pharmacoepidemiology, health services research, clinical pharmacology, informatics, biostatististics, and behavioral sciences. The specific aims of the CERT thus are: 1. Improve the knowledge base for rational pharmacotherapy by conducting clinical pharmacologic and pharmacoepidemiologic studies. We propose two pilot studies, one of factors influencing drug penetration of sanctuary sites and another comparing adverse effects of Cox 1 and Cox 2 NSAIDs. 2. Modify suboptimal provider or patient behavior through focused educational programs. 3. Determine the effects of policies on pharmacotherapy and clinical outcomes by conducting rigorous evaluations of program and policy changes.