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

项目摘要/摘要 降血糖药物的处方和坚持越来越多地受到健康的推动 保险因素，如高额的自付药物费用和限制使用的处方做法(例如 事先授权的要求)。这些类型的与成本相关的用药限制(定义为 共同支付、高免赔额、处方限制)可能会限制循证药物的适当使用， 尤其是在公式落后于快速发展的证据基础的情况下。例如，最近的证据 提示SGLT-2抑制剂和GLP-1受体激动剂降低心血管疾病(CVD)的风险 2型糖尿病和心血管风险升高患者的事件和死亡率。如果与成本相关的药物 限制在这些患者中使用循证的、指南推荐的治疗方法，它可能 最终会导致更糟糕的健康结果。这样的政策还会增加政府的行政负担 实践者，并导致提供者的职业倦怠。本提案的目标是开发一个面向提供商的 采取干预措施，解决与成本相关的限制，改善2型糖尿病患者的用药情况。它 有3个具体目标：1)检查与成本相关的用药限制和启动之间的联系 2型糖尿病(T2D)患者对新的二线降糖药物的使用和依从性 在有和没有建立心血管疾病的情况下，2)描述卫生保健经历的与成本相关的限制 寻求开降糖药物的供应商，以及他们如何应对这些限制 当代实践和3)开发和试行面向提供者的教育外展干预措施，以 帮助解决与成本相关的限制，并改善降血糖药物的最佳使用。这些 AIMS将与职业发展计划相辅相成，其中包括教学课程、参与 在研讨会和由瓦利德·盖拉德博士领导的杰出团队的密集指导下，瓦利德博士是一家由R01资助的公司 有成功指导K奖金获得者的记录的调查员。该计划填补了PI中的重要空白 并将生成试点数据，以形成后续R01应用程序的基础，以测试提供商是否- 面向教育的外展干预可以改善降糖药物的循证使用 以及2型糖尿病患者的临床结果。

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.