Assessing and Improving Arthritis Medication Adherence: Gout as a Model

描述（由申请人提供）：美国的一个主要公共卫生问题是药物依从性差。估计有50%的慢性病患者在接受药物治疗6个月后难以坚持其治疗方案。这会导致更差的临床结果，并增加医疗保健的利用率和成本。在关节炎和肌肉骨骼疾病中，不良依从性的后果尚未得到很好的探讨。痛风是检查缺乏坚持治疗的理想条件，因为它影响了多达500万美国人，其发病率正在上升。长期使用降尿酸药物（ULDs）可以有效治疗慢性痛风，这些药物相对便宜且副作用发生率低。然而，初步结果表明，只有40%的患者坚持使用ULDs。提案中概述的课程作业和一系列项目将使Harrold博士获得必要的培训和经验，成为一名独立研究者，进行研究，改善为风湿病患者提供的护理。拟议研究的总体目标是通过开发一种促进依从性的干预措施，为理解坚持使用超低剂量药物做出实质性的科学贡献。本研究的具体目的是：1)调查痛风患者不遵守ULDs的比率，并确定不遵守ULDs的危险因素；2)识别导致不依从的患者、提供者和系统因素；3)评估不遵医嘱对临床和成本结果的影响；4)开发和试点测试一种教育和电话咨询干预措施，以促进对目标的遵守。将分析现有的管理数据，以评估新使用ULDs的痛风患者的依从性，并从患者、提供者和卫生系统特征方面描述未依从性的个体。深入的病人和提供者访谈将进行探讨不遵守的原因。不依从性对临床结果和痛风相关医疗保健利用的影响将通过问卷调查和比较依从性患者和非依从性患者的管理数据进行前瞻性研究。最后，将开发和试验一种旨在促进遵守自选目标的教育和电话咨询干预措施。这项工作将为后续的R01应用提供关键的经验和试验数据。

DESCRIPTION (provided by applicant): A major public health problem in the United States is poor adherence with medications. An estimated 50% of persons prescribed pharmacological therapy for chronic conditions have difficulty adhering to their regimen after six months. This leads to worse clinical outcomes and increased health care utilization and cost. The consequences of poor adherence have not been well explored in arthritis and musculoskeletal conditions. Gout is an ideal condition in which to examine lack of adherence as it affects up to 5 million Americans, and its incidence is rising. Chronic gout is effectively treated with lifelong use of urate-lowering drugs (ULDs), and these agents are relatively inexpensive and have a low incidence of side effects. However, preliminary results suggest that only 40% of patients are adherent with ULDs. The coursework and series of projects outlined in the proposal will allow Dr. Harrold to gain the training and experience necessary to become an independent investigator conducting research that improves the care provided to patients with rheumatic diseases. The overall objective of the proposed study is to make a substantial scientific contribution to the understanding of adherence'with ULDs, with the development of an intervention to promote adherence. The specific aims of this research are: 1) investigate rates of nonadherence with ULDs in gout patients and identify risk factors for nonadherence; 2) identify patient, provider, and system factors that contribute to nonadherence; 3) assess the impact of nonadherence with ULDs on clinical and cost outcomes; and 4) develop and pilot test an educational and telephone counseling intervention to promote adherence with ULDs. Existing administrative data will be analyzed to assess adherence among gout patients who are new users of ULDs, and characterize the individuals who are nonadherent in terms of patient, provider, and health system characteristics. In-depth patient and provider interviews will be conducted to explore reasons for nonadherence. The impact of nonadherence in terms of clinical outcomes and gout-associated health care utilization will be examined prospectively using questionnaires and administrative data comparing adherent patients to nonadherent patients. Lastly, an educational and elephone counseling intervention designed to promote adherence with ULDs will be developed and pilot ested. This work will provide critical experience and pilot data for a subsequent R01 application.