Older Adults & Drug Decisions: Collaboration & Outcomes

描述（由申请人提供）：医生的时间压力越来越大，需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老年人。大量研究表明，老年人在探视期间比其他年龄组更被动。因此，医生可能会错过有关患者问题和可能影响健康结果的方案的关键信息。本研究解决了文献综述所确定的差距，要求研究评估干预措施，有效地引起患者对医生的访视前期望，并检查期望实现对患者结局的纵向影响。本研究的目的是研究干预的影响，确定老年患者的访视前关注，然后提示患者和医生在访问中解决这些问题。老年人的功能状态问题将在候诊室使用手持计算机进行简要识别。将向医生和患者提供一份总结患者反应的报告。我们假设，这种提示将影响性质的病人提供者遇到这样一种方式，健康结果将得到改善。为了检验这些假设，最终样本为580例年龄60岁或60岁以上的正式诊断为类风湿性关节炎的患者，将在他们的诊所访视时入组。将使用一项为期一年的随机对照实验，其中实验组患者接受计算机化评估并提示他们的访视问题，而对照组接受平行安慰剂计算机化评估他们的运动模式。在这两种情况下，患者评估摘要都在病历中提供给患者及其医生。将收集每例患者的基线、6个月和12个月数据。我们假设在12个月时改善疼痛和身体功能的主要结局的健康状况。选定的遭遇动力学假设，以帮助解释这些结果也将进行检查。我们将对病人与医生的接触进行录音，以研究这些互动动力学。主要分析将使用ANCOVA检查对照组和实验组之间在12个月时的差异，连续变量以基线结局值作为协变量，二分结局将主要通过Mantel Haenszel检验和logistic回归进行分析。

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.