Assessing and Improving Arthritis Medication Adherence: Gout as a Model

评估和改善关节炎药物依从性：痛风作为模型

• 批准号: 7679533
• 负责人: LESLIE R HARROLD
• 金额: $ 12.83万
• 依托单位: UNIV OF MASSACHUSETTS MED SCH WORCESTER
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-14 至 2012-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7679533
• 关键词: Abbreviations; Acute; Adherence; Admission activity; Adult; Adverse effects; Affect; Aging; American; American Heart Association; Arthritis; Blood; Caring; Cessation of life; Characteristics; Chronic; Chronic Childhood Arthritis; Classification; Clinic; Clinical; Colchicine; Colorado; Cost Effectiveness Analysis; Counseling; Data; Data Analyses; Databases; Deformity; Deposition; Development; Diabetes Mellitus; Disease; Drug usage; Elderly; Epidemiology; Facilities and Administrative Costs; Foundations; Goals; Gout; Gross National Product; HIV Infections; Health Care Costs; Health Maintenance Organizations; Health system; Heart; Hospitalization; Hospitals; Hypertension; ICD-9; Incidence; Individual; Institutes; Instruction; International; Intervention; Interview; Investigation; Kidney Diseases; Lung; Medical; Medical Records; Metabolic syndrome; Modeling; Musculoskeletal; National Heart, Lung, and Blood Institute; Nephrolithiasis; Non-Steroidal Anti-Inflammatory Agents; Nursing Homes; Obesity; Outcome; Pain; Patients; Persons; Pharmaceutical Preparations; Pharmacotherapy; Population; Prevalence; Principal Investigator; Provider; Public Health; Quality of Care; Questionnaires; Randomized Controlled Trials; Recurrence; Research; Research Personnel; Retrospective Studies; Rheumatism; Rheumatoid Arthritis; Rheumatology; Risk; Risk Factors; Series; Serum; Services; System; Systemic Lupus Erythematosus; Telephone; Testing; Thiazide Diuretics; Time; Training; Treatment Protocols; United Kingdom; United States; United States National Institutes of Health; Urate; Uric Acid; Wages; Work; cost; experience; falls; health care service utilization; improved; joint injury; medication compliance; member; programs; prophylactic; social cognitive theory; therapy design; therapy development

DESCRIPTION (provided by applicant): A major public health problem in the United States is poor adherence with medications. An estimated 50% of persons prescribed pharmacological therapy for chronic conditions have difficulty adhering to their regimen after six months. This leads to worse clinical outcomes and increased health care utilization and cost. The consequences of poor adherence have not been well explored in arthritis and musculoskeletal conditions. Gout is an ideal condition in which to examine lack of adherence as it affects up to 5 million Americans, and its incidence is rising. Chronic gout is effectively treated with lifelong use of urate-lowering drugs (ULDs), and these agents are relatively inexpensive and have a low incidence of side effects. However, preliminary results suggest that only 40% of patients are adherent with ULDs. The coursework and series of projects outlined in the proposal will allow Dr. Harrold to gain the training and experience necessary to become an independent investigator conducting research that improves the care provided to patients with rheumatic diseases. The overall objective of the proposed study is to make a substantial scientific contribution to the understanding of adherence'with ULDs, with the development of an intervention to promote adherence. The specific aims of this research are: 1) investigate rates of nonadherence with ULDs in gout patients and identify risk factors for nonadherence; 2) identify patient, provider, and system factors that contribute to nonadherence; 3) assess the impact of nonadherence with ULDs on clinical and cost outcomes; and 4) develop and pilot test an educational and telephone counseling intervention to promote adherence with ULDs. Existing administrative data will be analyzed to assess adherence among gout patients who are new users of ULDs, and characterize the individuals who are nonadherent in terms of patient, provider, and health system characteristics. In-depth patient and provider interviews will be conducted to explore reasons for nonadherence. The impact of nonadherence in terms of clinical outcomes and gout-associated health care utilization will be examined prospectively using questionnaires and administrative data comparing adherent patients to nonadherent patients. Lastly, an educational and elephone counseling intervention designed to promote adherence with ULDs will be developed and pilot ested. This work will provide critical experience and pilot data for a subsequent R01 application.

描述（由申请人提供）：美国的一个主要公共卫生问题是药物依从性差。据估计，接受慢性病药物治疗的人中有 50% 在六个月后难以坚持其治疗方案。这会导致更糟糕的临床结果并增加医疗保健利用率和成本。关节炎和肌肉骨骼疾病中依从性差的后果尚未得到充分研究。痛风是检查是否缺乏依从性的理想病症，因为它影响着多达 500 万美国人，而且其发病率正在上升。终身使用降尿酸药物（ULD）可以有效治疗慢性痛风，这些药物相对便宜且副作用发生率低。然而，初步结果表明，只有 40% 的患者坚持使用 ULD。提案中概述的课程和一系列项目将使 Harrold 博士获得必要的培训和经验，成为一名独立调查员，开展改善风湿性疾病患者护理的研究。拟议研究的总体目标是通过开发促进依从性的干预措施，为理解 ULD 的依从性做出重大科学贡献。本研究的具体目的是：1）调查痛风患者不遵守 ULD 的比例并确定不遵守的危险因素； 2) 识别导致不依从性的患者、提供者和系统因素； 3) 评估不遵守 ULD 对临床和成本结果的影响； 4) 制定并试点测试教育和电话咨询干预措施，以促进对 ULD 的遵守。将分析现有的管理数据，以评估作为 ULD 新用户的痛风患者的依从性，并根据患者、提供者和卫生系统特征来描述不依从性的个人。将进行深入的患者和提供者访谈，以探讨不依从的原因。将使用问卷和比较依从性患者与不依从性患者的管理数据来前瞻性地检查不依从性对临床结果和痛风相关医疗保健利用的影响。最后，将开发并试点旨在促进遵守 ULD 的教育和电话咨询干预措施。这项工作将为后续的 R01 应用提供关键经验和试点数据。