Adherence & Health Outcomes after Liver Transplantation

依从性

• 批准号: 7103805
• 负责人: CAROL S STILLEY
• 金额: $ 30.07万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-03-02 至 2010-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7103805
• 关键词: behavior prediction; behavioral /social science research tag; clinical research; disease /therapy duration; early /brief intervention /therapy; environmental stressor; human mortality; human subject; interview; lifestyle; liver transplantation; longitudinal human study; medical records; outcomes research; patient oriented research; prognosis; therapy compliance

DESCRIPTION (provided by applicant): The goal of this R01 application is to determine the extent to which patient factors impact on adherence and health outcomes after liver transplantation (LTX). Transplantation is the only option for survival of end stage liver disease; demand far exceeds supply yet little is known about which patients benefit most from the procedure. There are clear links between treatment adherence and health outcomes both in general medicine and in other transplant patient populations. Determining which LTX patients are at risk of non-adherence and suboptimal health outcomes is an ongoing dilemma for clinicians and a significant public health issue; failure to do so is costly to the healthcare system and society. The proposed research will be the first known prospective study of adherence to the multifaceted LTX regimen. Specific aims of this longitudinal study are to 1) prospectively characterize adherence to medication taking, appointment keeping, and recommended lifestyle changes over the first post-txp year and identify latent classes of adherence trajectories; 2) determine salient individual and environmental factors that underlie variation in adherence and predict health outcomes. Adherence will be tracked with interviews, electronic medication monitors, and medical records review over the first year; individual and environmental patient factors will be assessed with self report measures and interviews at 1-2, 6, and 12 months post-transplant; morbidity and, secondarily, mortality will be tracked with medical records review over the remainder of the study period. This study will be conducted in collaboration with the Thomas E. Starzl Institute, at the University of Pittsburgh Medical Center; all adult recipients who survive the acute post-transplant period will be eligible. Recruitment will occur over a 2.5 year period and sample size is projected to be approximately 300 recipients. The long-term goal of this project is to develop guidelines for transplant clinicians to identify patients prior to or early after transplantation who are at risk of non-adherence and sub-optimal health outcomes for targeted patient-specific interventions to maximize benefit of LTX. The application of this research would serve as the basis to advance significantly the nation's capacity to protect and preserve health in transplant populations.

描述(由申请人提供)：本R01申请的目标是确定患者因素对肝移植(LTX)后依从性和健康结果的影响程度。移植是终末期肝病生存的唯一选择；供不应求，但人们对哪些患者从这一过程中受益最大知之甚少。在普通医学和其他移植患者群体中，治疗依从性和健康结果之间都有明显的联系。确定哪些LTX患者存在未坚持治疗和健康结果不佳的风险，这对临床医生来说是一个持续的两难境地，也是一个重大的公共卫生问题；如果做不到这一点，医疗保健系统和社会将付出高昂的代价。这项拟议的研究将是已知的第一项关于坚持多方面LTX方案的前瞻性研究。这项纵向研究的具体目标是1)前瞻性地描述TXP后第一年对服药、预约和推荐的生活方式变化的遵守情况，并确定潜在的坚持轨迹类别；2)确定导致坚持不同的显著个人和环境因素，并预测健康结果。依从性将通过第一年的访谈、电子用药监视器和医疗记录审查来跟踪；个体和环境患者因素将在移植后1-2个月、6个月和12个月通过自我报告测量和访谈进行评估；发病率和死亡率将在研究剩余时间通过医疗记录审查进行跟踪。这项研究将与匹兹堡大学医学中心的托马斯·E·斯塔兹尔研究所合作进行；所有在急性移植后时期存活下来的成年受者都将符合条件。招聘将在两年半的时间内进行，预计样本规模约为300名接受者。该项目的长期目标是为移植临床医生制定指南，以确定哪些患者在移植前或移植后早期面临不坚持治疗的风险，并针对特定患者采取针对性的干预措施，以最大限度地提高LTX的益处。这项研究的应用将作为显著提高国家保护和维护移植人群健康的能力的基础。