Understanding Oral Anticoagulation Use and Success Among Patients with Psychiatric Multimorbidity in Atrial Fibrillation

项目摘要 我的长期职业目标是成为一名独立的药剂师研究员，具有精神病学方面的专业知识 心血管疾病中的多病研究。通过我的研究计划，我的目标是找出 “REAL”对老年精神疾病多发病患者健康及用药行为的影响 世界“观察性数据和患者和利益相关者的直接参与。我有临床(药学)和研究生学位 (博士)药剂学培训，我是东北大学药学系助理教授 药学与卫生系统科学。由K01奖项促成的培训将帮助我实现我的长期目标 通过建立我作为药剂师和研究人员的临床和技术技能并为我提供 有了必要的保护时间来扩大我在纵向数据分析、混合方法和 以患者为中心的心血管疾病和多发病研究。我召集了一位杰出的， 在与拟议研究相关的领域，由全国知名专家组成的承诺和跨学科团队 和我的长期目标。我的培训计划补充了我之前的培训和经验，并纳入了 与导师互动、正式课程、实践培训、研讨会、会议和研究活动。 使用混合方法设计，我的提案试图在我完成的初步工作的基础上 与NHLBI资助的正在进行的研究--心房老年因素的系统评估--建立伙伴关系 房颤(SAGE-AF)。我将利用目前在SAGE-AF中收集的观测数据来评估 精神病多发病的纵向影响(即抑郁、焦虑和认知的二联体和三联体 对心房颤动(AF)患者口服抗凝剂(OAC)的使用和预后的影响。我会检查一下 精神科多病与出血、药物治疗等临床结局的关系 坚持不懈。我还将研究精神疾病多发病和患者报告的结果之间的关系。 在医疗记录中不容易获得，但对患者、他们的家人和 临床医生如患者满意度和健康相关的生活质量。然后，我将进行圣人的焦点小组- 房颤参与者(92%的人表示愿意继续参加SAGE-房颤)和利益相关者了解保护性 影响精神病多发病患者抗凝成功的因素，包括因素 没有在SAGE-AF数据中进行评估。具体目的是：1)考察两者的关系 房颤患者的精神多发病与OAC处方；2)在OAC使用者中，检查纵向关联 精神科多发病和OAC成功指标和患者报告的结果之间的关系超过2年； 3)组织6-8个定性焦点小组，包括SAGE-AF参与者、他们的照顾者和临床医生， 确定影响OAC成功的因素。该提案通过以下方式与NHLBI的总体目标3保持一致 调查导致人群健康差异的因素，并有很高的潜力确定 可以作为以患者为中心的干预措施的有用目标的因素。

Project Summary My long-term career goal is to become an independent pharmacist researcher with expertise in psychiatric multimorbidity research in cardiovascular disease. Through my research program I aim to identify factors that influence the health and medication taking behaviors of older adults with psychiatric multimorbidity using “real world” observational data and direct patient and stakeholder engagement. I have clinical (PharmD) and graduate (PhD) training in pharmacy and I am an assistant professor at Northeastern University in the Department of Pharmacy and Health Systems Sciences. Training facilitated by this K01 award will help me achieve my long- term career goal by building on my clinical and technical skills as a pharmacist and researcher and providing me with the protected time necessary to expand my expertise in longitudinal data analysis, mixed methods and patient-centered research in cardiovascular disease and multimorbidity. I have assembled an outstanding, committed, and interdisciplinary team of nationally renowned experts in fields relevant to the proposed research and my long-term goals. My training plan complements my prior training and experience and incorporates interaction with mentors, formal coursework, hands-on training, workshops, conferences and research activities. Using a mixed methods design, my proposal seeks to build and expand on my preliminary work completed in partnership with the ongoing NHLBI funded study, Systematic Assessment of Geriatric Elements in Atrial Fibrillation (SAGE-AF). I will leverage observational data, currently being collected in SAGE-AF, to evaluate the longitudinal impact of psychiatric multimorbidity (i.e., dyads and the triad of depression, anxiety and cognitive impairment) on oral anticoagulant (OAC) use and outcomes in patients with atrial fibrillation (AF). I will examine relationships between psychiatric multimorbidity and clinical outcomes such as bleeding and medication adherence. I will also examine relationships between psychiatric multimorbidity and patient reported outcomes that are not readily available in the medical record but are increasingly important to patients, their families and clinicians such as patient satisfaction and health-related quality of life. Then, I will conduct focus groups of SAGE- AF participants (92% report willingness to continue in SAGE-AF) and stakeholders to understand protective factors that influence anticoagulation success among patients with psychiatric multimorbidity, including factors that are not evaluated in the SAGE-AF data. The specific aims are to: 1) Examine the relationship between psychiatric multimorbidity and OAC prescribing in AF; 2) Among OAC users, examine longitudinal associations between psychiatric multimorbidity and OAC success indicators and patient reported outcomes over 2 years; and 3) Conduct 6-8 qualitative focus groups including SAGE-AF participants, their caregivers and their clinicians, to identify factors that influence OAC success. This proposal aligns with NHLBI’s overarching objective 3 by investigating factors that account for differences in health among populations and has high potential to identify factors that can be useful targets for patient-centered interventions.