Cost-related Underuse of Medications and the Health of Older Adults

描述（由申请人提供）：与成本相关的药物不依从性和老年人的健康Becky Briesacher博士，是马萨诸塞州大学医学院老年医学系的健康服务研究员和医学助理教授。她的长期职业目标是成为一名独立资助的研究人员，在老龄化和药物政策领域获得丰富的指导和富有成效的合作。Briesacher博士寻求导师研究科学家发展奖（K01），以获得：（1）更好地了解成本相关的药物不依从性（CRN）及其对老年人健康的影响，以及（2）对健康行为中的非理性模型的研究经验。候选人提出职业发展计划，提供行为经济学的新培训，有针对性地接触临床老年医学，以及纵向分析中的先进统计方法。研究计划包括：（1）从两次全国老年人健康调查中创建一个独特的纵向数据集，（2）描述CRN的纵向过程，包括确定患者健康和医疗保健支出的预测因素和潜在后果，以及（3）开发老年人CRN模型，其中包括行为经济学的原则，特别是时间不一致性。高级培训和三部分研究计划将为Briesacher博士过渡到老年健康服务研究的独立调查员提供基础。此外，这项研究计划将告知医疗保险D部分处方药计划的核心问题及其对老年人健康和财务稳定的影响。相关性（参见说明）：强有力的证据表明，随着费用分担的增加，药物依从性下降，但药物费用分担正在上升，最明显的是在医疗保险D部分。发现最佳的成本分摊如何提高药物依从性对日益依赖药物的老龄化社会的健康和福利具有重要意义。

DESCRIPTION (provided by applicant): Cost-related Medication Nonadherence and the Health of Older Adults Becky Briesacher, Ph.D., is a health services researcher and Assistant Professor of Medicine in the Division of Geriatric Medicine at the University of Massachusetts Medical School. Her long-term career goal is to become an independently-funded researcher supported by rich mentorship and fruitful collaborations in the area of aging and drug policy. Dr. Briesacher seeks a Mentored Research Scientist Development Award (K01) to gain: (1) a better understanding of cost-related medication nonadherence (CRN) and its effect on the health of older adults, and (2) research experience with models that account for irrationality in health behaviors. The candidate proposes a career development plan that provides new training in behavioral economics, targeted exposure to clinical geriatrics, and advanced statistical methods in longitudinal analyses. The research program includes: (1) creating a unique, longitudinal dataset from two national health surveys of older adults, (2) describing the longitudinal course of CRN, including identifying the predictors and potential consequences on patient health and health care expenditures, and (3) developing models of CRN in older adults that incorporate principles from behavioral economics, particularly time-inconsistency. The advanced training and three-part research program will provide the foundation for Dr. Briesacher's transition to an independent investigator in geriatric health services research. In addition, this research program will inform issues central to Medicare Part D prescription drug program and its effects on the health and financial stability of older adults. RELEVANCE (See instructions): Strong evidence shows that medication adherence decreases with higher cost-sharing, yet medication cost- sharing is rising, most notably in Medicare Part D. Discovering how optimal cost-sharing may improve medication adherence has significant implications for the health and welfare of an aging society that is increasingly dependent on medications.