Optimization of hyperlipidemia management among patients with rheumatoid arthritis: A patient-centered intervention development

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Project Summary One of the greatest success stories in rheumatology - the achievement of rheumatoid arthritis (RA) remission - is tempered by the fact that individuals with RA are dramatically under evaluated and under treated to reduce cardiovascular disease (CVD) risk. This project will build the foundation for an intervention that will test the hypothesis that the patient-centered intervention tailored to the RA population that I will develop as part of this K23 will improve hyperlipidemia screening and treatment in RA, thereby reducing CVD risk. For the K23 and future projects, we will build on the University of Alabama at Birmingham (UAB)'s collaboration with the Patient-Centered Outcomes Research Institute (PCORI)-funded ArthritisPower Patient Powered Research Network (PPRN). We will work in partnership with members of ArthritisPower >2,000 RA patients and caregivers in all 50 US states. In this proposal, we will develop and test the feasibility of a novel theory-driven (Using Bandura's Social Cognitive Theory), patient-centered educational decision support/peer coaching intervention, thereby mastering foundational skills in the development and implementation of patient- engaged intervention research. The aims of this proposal are: Aim 1: To identify patient and physician barriers to CVD risk reduction in RA. During this aim, we will apply qualitative methods to elicit attitudes, beliefs and barriers regarding CVD and CVD risk reduction. Aim 2: To develop an intervention designed to optimize lipid screening and management in RA patients. We will build the intervention based on the data collected in Aim 1. This will consist of patient education and a decision support program to facilitate screening for hyperlipidemia or initiation of lipid lowering therapy (LLT) (primary outcome) and self-efficacy in taking lipid lowering therapy and patient activation (secondary outcome). Aim 3: To pilot test the intervention developed in Aim 2. During this aim, we will apply methods related to clinical trials to test the feasibility of the newly developed intervention. This study will result in a patient-centered intervention to facilitate the first steps needed to address the gap in screening and management of hyperlipidemia in RA. The long term goals include the development of a foundation to conduct a pragmatic trial of this intervention (and future studies) in collaboration with ArthritisPower. We will incorporate other modifiable CVD risk factors such as hypertension not only targeted to RA patients but to other rheumatic diseases and other vexing challenges in rheumatology such as medication/treatment adherence.