Adherence & Health Outcomes after Liver Transplantation

肝移植术后依从性与健康结局 此R01应用程序的目标是确定患者因素对依从性和 肝移植(LTX)后的健康结局。移植是终末期生存的唯一选择 肝病；供不应求，但对哪些患者受益最大却知之甚少 程序。一般说来，坚持治疗和健康结果之间有明显的联系。 在医学和其他移植患者群体中。确定哪些LTX患者存在非 依从性和次优健康结果是临床医生和重要公众持续面临的困境 健康问题；如果做不到这一点，医疗保健系统和社会将付出代价。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。这一行动的具体目标 纵向研究是为了1)前瞻性地表征对服药、预约、 并推荐了第一年后的生活方式变化，并确定了潜在的坚持类别 轨迹；2)确定显著的个人和环境因素，这些因素是依从性变化的基础 并预测健康结果。依从性将通过访谈、电子药物监测器和 第一年的病历审查；将评估患者的个人和环境因素 在移植后1-2个月、6个月和12个月时进行自我报告测量和访谈；发病率；其次， 在研究剩下的时间里，将通过审查医疗记录来跟踪死亡率。这项研究将 与匹兹堡大学托马斯·E·斯塔兹尔研究所合作进行 中心；所有在急性移植后时期存活的成年受者都将有资格。招聘将 调查发生在两年半的时间内，样本规模预计约为300人。长期的 该项目的目标是为移植临床医生制定指南，以便在移植前或移植后早期识别患者。 面临不依从性和目标患者健康结局不佳的风险的移植- 为最大限度地提高LTX效益的具体干预措施。本研究的应用将作为本研究的基础 显著提高国家保护和维护移植人群健康的能力。

Adherence and Health Outcomes after Liver Transplantation 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 iver 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 recommendedlifestyle changes over the first post-txpyear and identify latent classesof 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 assessedwith self report measures and interviews at 1-2, 6, and 12 months post-transplant; morbidity and, secondarily, mortality will be trackedwith 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 PittsburghMedical 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 targetedpatient- 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.