Understanding Oral Anticoagulation Use and Success Among Patients with Psychiatric Multimorbidity in Atrial Fibrillation

了解心房颤动精神多重病患者口服抗凝药的使用和成功

• 批准号: 10545003
• 负责人: Benita A Bamgbade
• 金额: $ 16.2万
• 依托单位: NORTHEASTERN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-01-01 至 2025-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10545003
• 关键词: Adherence; Adult; Adverse event; Affect; Anticoagulant therapy; Anticoagulants; Anticoagulation; Anxiety; Atrial Fibrillation; Behavior; Behavioral; Cardiovascular Diseases; Caregivers; Chronic; Client satisfaction; Clinical; Clinical Skills; Cohort Studies; Communities; Complement; Complex; Data; Data Analyses; Decision Making; Diabetes Mellitus; Diagnosis; Disease; Doctor of Pharmacy; Dose; Educational workshop; Elderly; Elements; Eligibility Determination; Event; Family; Focus Groups; Funding; Geriatric Assessment; Goals; Guidelines; Health; Health system; Healthcare; Hemorrhage; Impaired cognition; Intervention; Knowledge; Literature; Medical; Medical Records; Mental Depression; Mentored Research Scientist Development Award; Mentors; Mentorship; Methods; Monitor; National Heart, Lung, and Blood Institute; Oral; Outcome; Participant; Patient Outcomes Assessments; Patient-Focused Outcomes; Patients; Pharmaceutical Preparations; Pharmacists; Pharmacy facility; Population; Populations at Risk; Prevalence; Recommendation; Reporting; Research; Research Activity; Research Methodology; Research Personnel; Risk; Science; Stroke; Stroke prevention; Symptoms; Technical Expertise; Therapeutic; Time; Training; Universities; Warfarin; Woman; Work; career; clinical care; comorbidity; design; experience; health difference; health related quality of life; high risk; improved; insight; medication compliance; multiple chronic conditions; patient oriented; professor; programs; protective factors; response; socioeconomics; success; symposium; treatment and outcome; willingness

Project Summary My long-term career goal is to become an independent pharmacist researcher with expertise in psychiatric multimorbidity research in cardiovascular disease. Through my research program I aim to identify factors that influence the health and medication taking behaviors of older adults with psychiatric multimorbidity using “real world” observational data and direct patient and stakeholder engagement. I have clinical (PharmD) and graduate (PhD) training in pharmacy and I am an assistant professor at Northeastern University in the Department of Pharmacy and Health Systems Sciences. Training facilitated by this K01 award will help me achieve my long- term career goal by building on my clinical and technical skills as a pharmacist and researcher and providing me with the protected time necessary to expand my expertise in longitudinal data analysis, mixed methods and patient-centered research in cardiovascular disease and multimorbidity. I have assembled an outstanding, committed, and interdisciplinary team of nationally renowned experts in fields relevant to the proposed research and my long-term goals. My training plan complements my prior training and experience and incorporates interaction with mentors, formal coursework, hands-on training, workshops, conferences and research activities. Using a mixed methods design, my proposal seeks to build and expand on my preliminary work completed in partnership with the ongoing NHLBI funded study, Systematic Assessment of Geriatric Elements in Atrial Fibrillation (SAGE-AF). I will leverage observational data, currently being collected in SAGE-AF, to evaluate the longitudinal impact of psychiatric multimorbidity (i.e., dyads and the triad of depression, anxiety and cognitive impairment) on oral anticoagulant (OAC) use and outcomes in patients with atrial fibrillation (AF). I will examine relationships between psychiatric multimorbidity and clinical outcomes such as bleeding and medication adherence. I will also examine relationships between psychiatric multimorbidity and patient reported outcomes that are not readily available in the medical record but are increasingly important to patients, their families and clinicians such as patient satisfaction and health-related quality of life. Then, I will conduct focus groups of SAGE- AF participants (92% report willingness to continue in SAGE-AF) and stakeholders to understand protective factors that influence anticoagulation success among patients with psychiatric multimorbidity, including factors that are not evaluated in the SAGE-AF data. The specific aims are to: 1) Examine the relationship between psychiatric multimorbidity and OAC prescribing in AF; 2) Among OAC users, examine longitudinal associations between psychiatric multimorbidity and OAC success indicators and patient reported outcomes over 2 years; and 3) Conduct 6-8 qualitative focus groups including SAGE-AF participants, their caregivers and their clinicians, to identify factors that influence OAC success. This proposal aligns with NHLBI’s overarching objective 3 by investigating factors that account for differences in health among populations and has high potential to identify factors that can be useful targets for patient-centered interventions.

项目摘要 我的长期职业目标是成为一名独立的药剂师研究员， 心血管疾病的多学科研究。通过我的研究计划，我的目标是确定因素， 使用“真实的”影响老年精神病患者的健康和服药行为 世界”观察数据和直接患者和利益相关者参与。我有临床（药学博士）和研究生 (PhD)我是东北大学药学系的助理教授， 药学和卫生系统科学。K 01奖所提供的培训将帮助我实现我的长期目标- 通过建立我作为药剂师和研究人员的临床和技术技能， 与保护必要的时间，以扩大我的专业知识，在纵向数据分析，混合方法， 以患者为中心的心血管疾病和多发性硬化症研究。我召集了一位杰出的， 由与拟议研究相关领域的全国知名专家组成的忠诚的跨学科团队 我的长期目标。我的培训计划补充了我之前的培训和经验，并纳入了 与导师的互动、正式课程、实践培训、讲习班、会议和研究活动。 使用混合方法设计，我的建议旨在建立和扩大我在年完成的初步工作， 与正在进行的NHLBI资助的研究，心房老年因素的系统评估合作 房颤（SAGE-AF）。我将利用目前在SAGE-AF中收集的观测数据来评估 精神病多发病的纵向影响（即，抑郁、焦虑和认知障碍 心房颤动（AF）患者口服抗凝剂（OAC）使用和结局。我将研究 精神病性多发病与临床结局（如出血和药物治疗）之间的关系 坚持。我还将研究精神多发病和病人报告的结果之间的关系 这些信息在医疗记录中不容易获得，但对患者及其家人越来越重要， 临床医生，如患者满意度和健康相关的生活质量。然后，我将进行SAGE的焦点小组讨论- AF参与者（92%报告愿意继续SAGE-AF）和利益相关者了解保护性 影响精神病多发性硬化患者抗凝成功的因素，包括 SAGE-AF数据中没有评估的。具体目标是：（1）检查 AF患者中的精神病多药治疗和OAC处方; 2）在OAC使用者中，检查纵向关联 2年内精神多项指标和OAC成功指标与患者报告结局之间的关系; 和3）进行6-8个定性焦点小组，包括SAGE-AF参与者，他们的护理人员和他们的临床医生， 确定影响OAC成功的因素。该提案符合《无法律约束力文书》的总体目标3， 调查解释人群健康差异的因素，并有很大的潜力来确定 这些因素可以成为以患者为中心的干预措施的有用目标。