Developing a provider-facing intervention to address cost-related medication restrictions and improve medication use in patients with type 2 diabetes

制定面向医疗服务提供者的干预措施，以解决与费用相关的药物限制并改善 2 型糖尿病患者的药物使用

• 批准号: 10569117
• 负责人: Jing Luo
• 金额: $ 18.81万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-01 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10569117
• 关键词: Academic Detailing; Address; Adherence; Agonist; Award; Cardiovascular Diseases; Cardiovascular system; Clinical; Cluster randomized trial; Code; Community Practice; Complement; Cost Sharing; Data; Databases; Deductibles; Development Plans; Diabetes Mellitus; Drug Prescriptions; Education and Outreach; Educational workshop; Effectiveness; Enrollment; Event; Formularies; Foundations; Funding; GLP-I receptor; Glucose; Glucose Transporter; Goals; Guidelines; Health; Health Insurance; Health Personnel; Health system; Insurance Carriers; Intervention; Interview; Knowledge; Measures; Medical; Medicare; Medicine; Mentors; Mentorship; Methods; Modeling; National Institute of Diabetes and Digestive and Kidney Diseases; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Patient-Focused Outcomes; Patients; Pharmaceutical Preparations; Policies; Price; Process; Provider; Recommendation; Reporting; Research; Research Personnel; Risk; Risk Factors; Risk Reduction; Sodium; Structure; Testing; Training; Training Activity; Transcript; acceptability and feasibility; barrier to care; basal insulin; burnout; cardiovascular disorder risk; cardiovascular risk factor; career; career development; clinical outcome measures; cohort; copayment; cost; design; evidence base; experience; follow-up; improved; inhibitor; medication compliance; mortality; pilot test; poor health outcome; primary care provider; primary care setting; prior authorization; recruit; theories

Project Summary/Abstract The prescribing of, and adherence to, glucose-lowering medications is increasingly being driven by health insurance factors such as high out-of-pocket medication costs and formulary practices that restrict use (e.g. requirements for prior authorization). These types of cost-related medication restrictions (defined as high copayments, high deductibles, formulary restrictions) can limit appropriate use of evidence-based medications, especially when formularies lag behind a rapidly evolving evidence base. For example, recent evidence suggests that SGLT-2 inhibitors and GLP-1 receptor agonists reduce the risk of cardiovascular disease (CVD) events and mortality in patients with type 2 diabetes and elevated CV risk. If cost-related medication restrictions limit the use of evidence-based, guideline recommended therapies in these patients, it may ultimately result in worse health outcomes. Such policies can also increase administrative burden for the practitioner and contribute to provider burnout. The goal of this proposal is to develop a provider-facing intervention to address cost-related restrictions and improve medication use for patients with type 2 diabetes. It has 3 specific aims: 1) To examine the association between cost-related medication restrictions and initiation of, and adherence to, newer 2nd line glucose-lowering medications among patients with type 2 diabetes (T2D) with and without established CVD, 2) To describe the cost-related restrictions experienced by health care providers seeking to prescribe glucose-lowering medications, and how they respond to such restrictions in contemporary practice and 3) To develop and pilot test a provider-facing, educational outreach intervention to help address cost-related restrictions and improve the optimal use of glucose lowering medications. These aims will be complemented by a career development plan that incorporates didactic coursework, participation in workshops, and intensive mentorship under an outstanding team led by Dr. Walid Gellad, an R01-funded investigator with a track record of successfully mentoring K awardees. The plan fills important gaps in the PI’s training and will generate pilot data to form the basis of a follow-up R01 application testing whether a provider- facing educational outreach intervention can improve the evidence-based use of glucose lowering medications and clinical outcomes for patients with type 2 diabetes.

项目总结/文摘