Older Adults & Drug Decisions: Collaboration & Outcomes

老年人

• 批准号: 6547472
• 负责人: BETTY Ann CHEWNING
• 金额: $ 58.21万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-09-15 至 2006-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6547472
• 关键词: audiotape; clinical research; clinical trials; communication; computer assisted medical decision making; drug screening /evaluation; functional ability; human old age (65+); human subject; longitudinal human study; outcomes research; pain; patient care personnel relations; physicians; questionnaires; rheumatoid arthritis

DESCRIPTION (provided by applicant): Midst growing time pressures on physicians, there is a need to maintain and even enhance the quality of physician-patient encounters, particularly for vulnerable, older adults with chronic conditions. Substantial research suggests that older adults are more passive than other age groups during their visits. Hence, physicians may miss key information about patient concerns and regimens that could affect health outcomes. This research addresses gaps identified by literature reviews calling for studies evaluating interventions that efficiently elicit patient pre-visit expectations for physicians and examine the longitudinal effect of expectation fulfillment on patient outcomes. The goal of this research is to study the impact of an intervention that identifies pre-visit concerns of older adult patients and then prompts both patients and physicians to address these concerns in the visit. Older adults' functional status concerns will be identified briefly in the waiting room using a handheld computer. A printout summarizing patient responses will be given both to the physician and patient. We hypothesize that this prompt will affect the nature of the patient-provider encounter in such a way that health outcomes will be improved. To test these hypotheses, a final sample of 580 patients age 60 or older, with a formal diagnosis of rheumatoid arthritis will be enrolled at their clinic visit. A one-year randomized, controlled experiment will be used in which an experimental group patients receive a computerized assessment and prompt about their visit concerns while a control group receives a parallel placebo computerized assessment of their exercise patterns. In both cases, patient assessment summaries are given to the patients and to their physicians in the medical record. Baseline, 6 month and 12 month data will be collected on each patient. We hypothesize improved health status at 12 months for the primary outcomes of pain and physical function. Selected encounter dynamics hypothesized to help explain these outcomes will also be examined. We will audiotape patient-physician encounters to study these interaction dynamics. The primary analyses will examine differences at 12 months between the control and experimental groups using ANCOVA for continuous variables with baseline values of outcomes as a covariate, Dichotomous outcomes will be analyzed primarily by the Mantel Haenszel test and logistic regression.

描述(由申请人提供)：在医生面临越来越大的时间压力的情况下，有必要保持甚至提高医患接触的质量，特别是对于患有慢性病的脆弱的老年人。大量研究表明，老年人在访问期间比其他年龄段的人更被动。因此，医生可能会遗漏有关患者关注的问题和可能影响健康结果的治疗方案的关键信息。这项研究解决了文献综述中发现的空白，呼吁进行研究，评估有效地引起患者对医生的访问前期望的干预措施，并检查期望实现对患者结果的纵向影响。这项研究的目的是研究一项干预措施的影响，该干预措施确定老年患者就诊前的担忧，然后促使患者和医生在就诊中解决这些担忧。老年人的功能状态问题将在等候室使用手持计算机进行简短识别。一份总结患者反应的打印输出将同时提供给医生和患者。我们假设这一提示将以一种改善健康结果的方式影响患者-提供者遭遇的性质。为了验证这些假设，将在临床就诊时登记580名60岁或以上、被正式诊断为类风湿性关节炎的患者的最终样本。一项为期一年的随机对照实验将被使用，其中一组患者接受计算机化的评估并提示他们的就诊问题，而控制组接受一项平行的安慰剂计算机评估，评估他们的运动模式。在这两种情况下，患者评估摘要都会在医疗记录中提供给患者和他们的医生。将收集每个患者的基线、6个月和12个月的数据。我们假设疼痛和身体功能的主要结果是在12个月时健康状况有所改善。选定的遭遇动力学假设也将被检验，以帮助解释这些结果。我们将录制患者与医生见面的录音，以研究这些互动动力学。初步分析将在12个月时检验控制组和试验组之间的差异，使用ANCOVA为连续变量，结果基线值为协变量，二分结果将主要通过Mantel Haenszel检验和Logistic回归进行分析。