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.

项目摘要/摘要 越来越多的处方并遵守降解葡萄糖的药物受到健康的驱动 诸如限制使用的高自付药物成本和公式化实践之类的保险因素（例如 事先授权的要求）。这些类型的与成本相关的药物限制（定义为高 共付额，高扣除额，公式性限制）可以限制适当使用循证药物， 尤其是当配制落后于迅速发展的证据基础时。例如，最近的证据 表明SGLT-2抑制剂和GLP-1受体激动剂降低了心血管疾病（CVD）的风险 2型糖尿病患者的事件和死亡率和CV风险升高。如果与成本有关的药物 限制限制了在这些患者中使用基于证据的指南建议疗法的使用，它可能 最终导致健康状况较差。此类政策还可以增加行政烧伤 从业者并为提供者倦怠做出贡献。该提案的目的是开发面向提供商的 干预措施以解决与成本有关的限制并改善2型糖尿病患者的药物使用。它 具有3个具体目标：1）检查与成本相关的药物限制与启动之间的关联 2型糖尿病患者（T2D）患者的较新的第二线降糖药物（T2D） 有或没有既定的CVD，2）描述医疗保健所带来的与成本相关的限制 寻求准备降糖药物的提供者以及他们如何应对此类限制 当代实践和3）开发和试点测试针对提供者的教育外展干预措施 有助于解决与成本有关的限制，并改善降低葡萄糖药物的最佳使用。这些 AIMS将由一项职业发展计划完成，该计划结合了教学课程，参与 在Walid Gellad博士领导的一支杰出团队的领导下，在研讨会上，以及R01资助的杰出团队 具有成功心理K获奖者的记录的调查员。该计划填补了PI的重要空白 培训并将生成试点数据，以构成后续r01应用程序测试的基础 面对教育外展干预可以改善基于证据的降低葡萄糖药物的使用 2型糖尿病患者的临床结局。