权益分类	功能权益	普通用户	{{item.name}}会员
{{category.name}}	{{benefitItem.name}}

Improving Access to Hydroxyurea for Adults with Sickle Cell Disease

改善镰状细胞病成人患者获得羟基脲的机会

基本信息

批准号：
8712543
负责人：
SOPHIE M LANZKRON
金额：
$ 35.08万
依托单位：
JOHNS HOPKINS UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-08-05 至 2016-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8712543
关键词：
Accident and Emergency department Address Adherence Adult Attitude Behavior Therapy Clinic Clinic Visits Code Communities Consensus Counseling Data Disease Goals Grant Health Hematologist Hematology Hospitalization Hospitals Improve Access Inpatients Intervention Knowledge Lead Multicenter Trials Multimedia Nurses Oncologist Online Systems Patient Noncompliance Patients Pharmacologic Substance Pharmacy facility Physicians Preparation Problem Solving Protocols documentation Provider Randomized Randomized Clinical Trials Rare Diseases Resources Sickle Cell Anemia Testing Time Toxic effect Training United States National Institutes of Health Visit abstracting arm base compliance behavior design experience hydroxyurea improved interest multi-component intervention oncology patient population primary outcome public health relevance randomized trial sickling therapy design tool treatment as usual

项目摘要

DESCRIPTION (provided by applicant): Our overall goal is to improve utilization of hydroxyurea for adults with sickle cell disease. Hydroxyurea (HU) therapy is currently the only disease-modifying pharmaceutical agent available to treat adult patients with sickle cell anemia (SCA). A recent NIH consensus panel reviewed the available evidence regarding HU treatment for SCD and found it to be safe, efficacious, and effective (Brawley et al., 2008). This review also found HU to be highly underutilized. We have previously identified provider barriers to the use of HU which included many concerns about patient compliance and concerns over toxicity. As SCD is a rare disorder, a large multistate study will be needed to test interventions to improve utilization of HU in this patient population. The design of this large trial will entail having hem/onc providers participate in a web based intervention to improve knowledge and decrease barriers to prescribing HU and then randomize their patients to an intervention to improve adherence. The primary aim of this large multicenter trial will be to demonstrate that the intervention decreases hospital and emergency room visits for adults with SCD eligible for HU. The purpose of this R34 grant is to gather data needed in order to do the larger study. With this grant we well characterize the patients seen by community hematologist/oncologists (Aim1), refine and test (Aim 2) a behavioral intervention designed to reduce the informational and attitudinal factors which contribute to hematologists/oncologists reluctance to prescribe HU to SCD patients and finally assess the feasibility (Aim 3) of training clinic staff to provide problem solving to patients to improve adherence to HU. Based on data from our previous studies on provider identified barriers to HU our central hypothesis is that lack of knowledge by hematologists/oncologists regarding the management of HU, as well a lack of appropriate tools to overcome barriers to its use, significantly contribute to the underutilization of HU.

描述（由申请人提供）：我们的总体目标是提高镰状细胞病成人患者对羟基脲的利用率。羟基脲（HU）疗法是目前唯一可用于治疗镰状细胞性贫血（SCA）成年患者的疾病缓解药物。最近的 NIH 共识小组审查了有关 HU 治疗 SCD 的现有证据，发现其安全、有效且有效（Brawley 等，2008）。该审查还发现 HU 的利用率极低。我们之前已经确定了医疗服务提供者使用 HU 的障碍，其中包括对患者依从性的许多担忧和对毒性的担忧。由于 SCD 是一种罕见疾病，因此需要进行大型多州研究来测试干预措施，以提高该患者群体中 HU 的利用率。这项大型试验的设计需要让 hem/onc 提供商参与通过基于网络的干预措施来提高知识并减少开 HU 处方的障碍，然后将患者随机分配到干预措施中以提高依从性。这项大型多中心试验的主要目的是证明干预措施可以减少符合 HU 资格的 SCD 成人的医院和急诊室就诊次数。 R34 拨款的目的是收集进行更大规模研究所需的数据。通过这笔拨款，我们很好地描述了社区血液学家/肿瘤学家所见的患者（目标 1），完善和测试（目标 2）行为干预措施，旨在减少导致血液学家/肿瘤学家不愿意向 SCD 患者开 HU 处方的信息和态度因素，并最终评估培训诊所工作人员为患者提供问题解决方案以提高 HU 依从性的可行性（目标 3）。根据我们之前对提供者确定的 HU 障碍的研究数据，我们的中心假设是，血液学家/肿瘤学家缺乏有关 HU 管理的知识，以及缺乏适当的工具来克服其使用障碍，这在很大程度上导致了 HU 的利用不足。