Enhancing treatment adherence and health outcomes

描述（由申请人提供）：本提案要求支持一项新的博士后培训计划，以培养医学博士和博士研究人员，在坚持医疗和慢性病管理方面开展创新，高影响力的研究，以提高患有儿科慢性病的儿童的健康结果。现代医学治疗改善了大量患有慢性病的儿童和青少年的健康状况。然而，在改善儿童终生慢性病管理过程中健康结果的最关键障碍之一是不遵守规定的药物治疗。不依从被定义为处方治疗（药物或其他治疗）与患者实际服用之间的差异。正如世界卫生组织（世卫组织）所指出的，治疗不依从不仅非常普遍（儿科慢性病人群的比率为50%或更高），而且对儿童的健康和卫生保健费用产生了非同寻常的负面影响。将需要进行创新和临床相关的研究，以缩小通过更优化的治疗依从性可能实现的健康结果与目前实践所取得的健康结果之间的差距。NIH项目的优先级和申请、科学共识会议和学术评论都确定了儿科治疗依从性研究的关键重要性。阻碍儿科依从性和慢性疾病管理研究科学进步的一个关键障碍是缺乏有才华、训练有素的研究人员，他们致力于儿科人群的创新、高影响力的治疗依从性和慢性疾病管理研究。解决这一需求并改善儿童健康的最有希望的方法之一是开发创新的跨学科研究培训计划，以培养治疗依从性和慢性病管理研究领域的领导者。这就是拟议计划的目标。具体的培训创新将涉及生物医学、行为学、生物统计学和卫生服务/成果研究的整合，并反映在全面的培训课程和研究机会中。研究创新包括涉及技术（远程保健、互联网、手机）的促进依从性干预的新方法，旨在增强干预效果的力量和持续时间，并覆盖不容易获得传统临床方法的不同人群。新的研究培训机会也将加强项目的创新，以评估坚持治疗促进干预在儿童慢性疾病管理中的相对有效性，整合客观的坚持治疗测量方法（如行为和药理学），并进行先进的统计分析，以评估坚持治疗促进干预对儿童健康结果的影响。

DESCRIPTION (provided by applicant): This proposal requests support for a new postdoctoral training program to train MD and PhD researchers to assume leadership roles in developing innovative, high impact research on adherence to medical treatment and chronic illness management that will enhance the health outcomes of children with pediatric chronic conditions. Modern medical treatments have improved the health outcomes of large numbers of children and adolescents with chronic conditions. However, one of the most critical remaining barriers to improving children's health outcomes over the course of their lifetime management of chronic illness is nonadherence to prescribed medical treatment. Nonadherence is defined as the discrepancy between prescribed treatment (medication or other treatments) and what is actually taken by patients. As noted by the World Health Organization (WHO), treatment nonadherence is not only highly prevalent (rates of 50% or greater in pediatric chronic illness populations) but has an extraordinary negative impact on children's health and health care costs. Innovative and clinically relevant research will be needed to close the gap between the health outcomes that are potentially achievable with more optimal treatment adherence and those achieved in current practice. NIH program priorities and requests for applications, scientific consensus conferences, and scholarly reviews have all identified the critical importance of research on pediatric adherence to treatment. A critical barrier to scientific advances in pediatric adherence and chronic illness management research is the shortage of talented, well-trained researchers who are devoting their careers to developing innovative, high impact treatment adherence and chronic illness management research with pediatric populations. One of the most promising ways to address this need and improve child health is to develop innovative interdisciplinary research training programs to train leaders in the field of treatment adherence and chronic illness management research. This is the goal of the proposed program. Specific training innovations will involve the integration of biomedical, behavioral, biostatistics, and health services/outcomes research and are reflected in a comprehensive training curriculum and research opportunities. Research innovations include novel methods of adherence promotion interventions involving technology (telehealth, internet, cell phone) designed to enhance the power and duration of intervention effects and reach diverse populations who cannot easily access traditional clinic-based approaches. Program innovation will also be enhanced by novel research training opportunities to evaluate the comparative effectiveness of adherence promotion interventions in pediatric chronic illness management, to integrate objective methods of adherence measurement (e.g., behavioral and pharmacological) and conduct advanced statistical analyses to evaluate the impact of adherence promotion interventions on children's health outcomes.