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Improving medication adherence and disease control for patients with multimorbidity: the role of price transparency tools

提高多病患者的药物依从性和疾病控制：价格透明度工具的作用

基本信息

批准号：
10591441
负责人：
Caroline Ellen Sloan
金额：
$ 18.69万
依托单位：
DUKE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-01-01 至 2027-12-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10591441
关键词：
Academic Medical Centers Address Adherence Adopted Affect Assessment tool Award Caring Cessation of life Characteristics Chronic Clinical Clinics and Hospitals Colorado Complex Cost-Sharing Insurance Data Decision Making Dedications Development Diabetes Mellitus Disease Progression Dose Drug Prescriptions Elderly Electronic Health Record Environment Evaluation Financial Support Foundations Frequencies General Population Geography Glycosylated hemoglobin A Goals Health Services Health system Healthcare Hospitalization Improve Access Institution Internist Intervention Interview Mediating Medical Medicare Mentored Patient-Oriented Research Career Development Award Mentors Mentorship Methods Outcome Patient-Focused Outcomes Patients Pattern Perception Pharmaceutical Preparations Pharmacy facility Policies Policy Analysis Price Privatization Program Evaluation Reporting Research Research Personnel Retrospective cohort study Role Site Structure Subgroup Time Training United States Centers for Medicare and Medicaid Services Universities acceptability and feasibility aged barrier to care career comorbidity cost cost estimate design diabetes control disorder control effectiveness evaluation electronic health record system experience high risk implementation tool improved insurance plan medication compliance middle age multiple chronic conditions novel older patient patient population primary care provider tool uptake usability virtual

项目摘要

Dr. Sloan is a general internist and health services researcher whose long-term career goal is to evaluate the effectiveness of policies and interventions that address barriers to care for older adults with multimorbidity. Many patients with multimorbidity struggle to pay for their medications. These patients have lower medication adherence, resulting in a higher risk of disease progression, functional limitations, hospitalization, and death. Patients cannot account for medication costs in their medical decisions, because they rarely know what those costs will be before getting to the pharmacy. If clinicians could access information about their patients’ medica- tion-related out-of-pocket costs at the point-of-prescribing, they could help their patients apply for financial sup- port, or prescribe lower-cost alternatives. New out-of-pocket drug price transparency tools could fill this need. The Centers for Medicare and Medicaid Services recently mandated that Medicare Part D plans make clinician- facing out-of-pocket drug price transparency tools available to clinics and hospitals via the electronic health record (EHR). No one has described the uptake and acceptability of these tools, or their impact on clinical out- comes among middle-aged and older patients with multimorbidity. The goal of this K23 award is to evaluate how primary care providers at one large academic health system use a widely available price transparency tool and how price transparency at the point-of-prescribing affects clinical outcomes for middle-aged and older patients with multimorbidity. This health system’s price transparency tool, adopted in 2019, is compatible with all Medicare plans and ~95% of private insurance plans in its state. In Aims 1 and 2, Dr. Sloan will describe the uptake and acceptability of the price transparency tool using an ex- planatory sequential mixed methods design. In Aim 1, she will conduct an EHR-based retrospective cohort study of ~700 clinicians and ~140,000 patients aged >50 with multimorbidity to determine the clinician and patient factors associated with use. In Aim 2, she will conduct ~24 semi-structured interviews to explore reasons for use / non-use that may not be readily available in EHR data. Interviews will also assess the tool’s acceptability and feasibility for use among patients with multimorbidity. In Aim 3, she will conduct an EHR- and claims-based longitudinal retrospective cohort study to evaluate how use of the tool affects adherence and diabetes control in a subgroup of ~29,000 patients aged >50 with diabetes and multimorbidity. Throughout the award, Dr. Sloan will pursue training in geriatric and multimorbidity research, medical deci- sion-making, mixed methods, and program evaluation methods. Results from this award will directly inform the development of a multisite evaluation of price transparency tool implementation at institutions with different ge- ographies, patient populations, and practice patterns. The rigorous training and mentorship provided by this award, as well as Duke University’s superb research environment, will prepare Dr. Sloan well for a career dedi- cated to improving access to affordable care for middle-aged and older adults with multimorbidity.

斯隆博士是一名普通内科医生和卫生服务研究员，其长期职业目标是评估政策和干预措施的有效性，以解决对患有多种疾病的老年人的护理障碍。许多患有多发性硬化症的患者难以支付药物费用。这些患者的药物用量较低依从性，导致疾病进展、功能限制、住院和死亡的风险更高。患者无法在他们的医疗决定中解释药物费用，因为他们很少知道这些费用是什么。在到达药房之前，费用将是。如果临床医生可以访问病人的药物信息- 在开处方时，他们可以帮助病人申请财政支持，港口，或开出低成本的替代品。新的自费药品价格透明度工具可以满足这一需求。医疗保险和医疗补助服务中心最近规定，医疗保险D部分计划使临床医生- 面对诊所和医院可通过电子卫生系统获得的自付药品价格透明度工具，记录（EHR）。没有人描述这些工具的吸收和可接受性，或它们对临床的影响。多发于中老年患者。这个K23奖的目标是评估一个大型学术卫生系统的初级保健提供者如何使用广泛可用的价格透明度工具，以及处方点的价格透明度如何影响中老年多发性硬化症患者的临床结局。该医疗系统的价格透明度该工具于2019年采用，与该州所有医疗保险计划和约95%的私人保险计划兼容。在目标1和2，斯隆博士将描述价格透明度工具的吸收和可接受性，使用一个前，平面序贯混合方法设计在目标1中，她将进行一项基于EHR的回顾性队列研究约700名临床医生和约140，000名年龄>50岁的多发病患者，以确定临床医生和患者与使用相关的因素。在目标2中，她将进行约24次半结构化访谈，以探索使用的原因 /不使用，可能不容易在EHR数据。访谈还将评估工具的可接受性，在多发性骨髓瘤患者中使用的可行性。在目标3中，她将进行基于EHR和索赔的一项纵向回顾性队列研究，旨在评估工具的使用如何影响患者的依从性和糖尿病控制，约29，000例年龄>50岁的糖尿病和多发性硬化症患者的亚组。在整个奖项，斯隆博士将继续在老年医学和多发病研究，医疗决策，方案制定、混合方法和方案评估方法。该奖项的结果将直接通知开发多地点价格透明度评价工具，在具有不同性别的机构实施，地理、患者人群和实践模式。这所学校提供的严格培训和指导奖项，以及杜克大学的一流的研究环境，将准备斯隆博士的职业生涯dedi很好，致力于改善患有多发性硬化症的中老年人获得负担得起的护理的机会。