The Effects of Visit Characteristics on Patient-Clinician Interactions and Health Outcomes in Knee Osteoarthritis

项目摘要/摘要 非特异性/非药物治疗效果可以改善健康状况，然而，知之甚少。 关于如何最大化这些影响，特别是与患者-临床医生互动相关的影响。这些 在治疗慢性疼痛时，效果尤其重要。初步研究表明，两人的访问量都有所增加 长度和增加的访问内容(旨在引起对个人的全面了解)增强了非 具体影响与患者与临床医生的互动有关，但尚不清楚这些因素中哪一个更重要 或者他们的互动是否是协同的。这项提议的长期目标是推进非特定的科学 治疗效果与患者与临床医生之间的互动有关，以改善健康结果。它的目标是 量化增加访问时长和增加访问内容的相对影响和机制 影响膝关节骨关节炎(OA)患者与临床医生的互动和健康结局。膝盖骨关节炎是一个理想的选择 研究就诊时间和内容对患者-临床医生互动和健康影响的条件 结果，因为它是老年人慢性疼痛和残疾的主要原因，许多常见的治疗方法 安全性差，治疗膝骨性关节炎的药物临床试验表明，非特异性治疗 效果是治疗效果的主要组成部分。中心假设是，两者都增加了访问量 延长访问时间和增加访问内容将增加与双氯芬酸相关的非特异性治疗效果 凝胶(一种治疗膝盖骨关节炎相关疼痛的标准局部疗法)。项目的具体目标是：1)确定是否 增加就诊时间和/或增加就诊内容可增加双氯芬酸的非特异性治疗效果 凝胶对膝盖骨关节炎疼痛和功能的影响；2)确定就诊时间和内容对患者和临床医生的影响 患者与临床医生互动期间的行为和生理；以及3)确定患者COMT 基因改变了访问长度增加和访问内容增加对膝关节疼痛的影响。该方法 创新之处在于，很少有针对与患者相关的非特异性影响的随机试验 临床医生的互动，没有直接测试就诊时间和内容对健康结果或使用的影响 评估患者与临床医生互动的生理学措施。这项拟议的研究意义重大，因为它将 确定就诊时间和内容对膝骨性关节炎患者健康结局的相对贡献 了解潜在的临床、行为、生理和遗传机制，通过这些机制 具体影响会影响健康结果。这一项目推进了一系列专注于改进 通过开发和测试策略来修改临床护理提供以最大限度地提高非 与患者-临床医生互动相关的特定治疗效果。它还将有助于开发新的研究 研究病人与临床医生相互作用的方法。从该项目中获得的见解也将与 其他慢性和痛苦的情况，可能有助于减少老年人中的多药治疗，并将促进 了解非特异性治疗效果在健康结果中的作用。

Project Summary/Abstract Non-specific/non-pharmacologic therapeutic effects can improve health outcomes, however, little is known about how to maximize these effects, particularly for effects related to patient-clinician interactions. These effects are especially important in treating chronic pain. Preliminary studies indicate that both increased visit length and augmented visit content (designed to elicit a holistic understanding of the individual) enhance non- specific effects related to patient-clinician interactions, but it is unclear which of these factors is more important or if their interaction is synergistic. This proposal’s long-term goal is to advance the science of non-specific therapeutic effects related to patient-clinician interactions to improve health outcomes. Its objective is to quantify the relative effects of, and mechanisms by which, increased visit length and augmented visit content affect patient-clinician interactions and health outcomes in knee osteoarthritis (OA). Knee OA is an ideal condition for studying the effects of visit length and content on patient-clinician interactions and health outcomes because it is a leading cause of chronic pain and disability in older adults, many common treatments have poor safety profiles, and clinical trials of medications for knee OA suggest that non-specific therapeutic effects account for a major component of treatment effects. The central hypothesis is that both increased visit length and augmented visit content will increase the non-specific treatment effects associated with diclofenac gel (a standard topical treatment for knee OA-related pain). Project specific aims are: 1) To determine whether increased visit length and/or augmented visit content increase the non-specific treatment effects of diclofenac gel on knee OA pain and function; 2) To determine how visit length and content affect patient and clinician behaviors and physiology during patient-clinician interactions; and 3) To determine whether patient COMT genotype modifies the effects of increased visit length and augmented visit content on knee pain. The approach is innovative in that there are few randomized trials targeting non-specific effects associated with patient- clinician interactions, and none that directly test the effects of visit length and content on health outcomes or use physiologic measures to assess patient-clinician interactions. The proposed study is significant because it will determine the relative contributions of visit length and content on health outcomes in knee OA and advance understanding of potential clinical, behavioral, physiologic, and genetic mechanisms through which non- specific effects impact health outcomes. This project advances a line of research focused on improving outcomes in knee OA by developing and testing strategies to modify clinical care delivery to maximize non- specific therapeutic effects associated with patient-clinician interactions. It will also help develop new research approaches for studying patient-clinician interactions. Insights gained from this project will also be relevant to other chronic and painful conditions, may help reduce polypharmacy among older adults, and will advance understanding of the roles of non-specific therapeutic effects in health outcomes.