Adherence & Health Outcomes after Liver Transplantation

肝移植术后的依从性和健康结局 本R 01应用程序的目标是确定患者因素对依从性的影响程度， 肝移植（LTX）后的健康状况。移植是终末期生存的唯一选择 艾弗疾病;需求远远超过供应，但很少有人知道哪些患者受益最多， procedure.一般来说，治疗依从性和健康结果之间存在明显的联系， 医学和其他移植患者群体。确定哪些LTX患者有非- 坚持和次优的健康结果是临床医生和重要公众的持续困境 健康问题;不这样做对医疗保健系统和社会来说是昂贵的。拟议的研究将是 这是已知的第一个关于多方面LTX方案依从性的前瞻性研究。具体目标 纵向研究是为了1）前瞻性地表征服药，预约， 并建议在治疗后的第一年改变生活方式， 轨迹; 2）确定突出的个人和环境因素，在坚持变化的基础 并预测健康结果。依从性将通过访谈、电子药物监测器和 第一年的病历审查;将评估患者的个人和环境因素， 移植后1-2、6和12个月的自我报告测量和访谈;发病率，其次， 死亡率将在研究期间的剩余时间内通过医疗记录审查进行跟踪。本研究将 与托马斯E.斯塔兹尔研究所，在汉堡大学医学 中心;所有在移植后急性期存活的成年受者都有资格。招聘将 发生在2.5年的时间里，预计样本量约为300名接受者。长期 该项目的目标是为移植临床医生制定指南，以在移植前或移植后早期识别患者 对于目标患者而言，移植患者面临不依从和次优健康结果的风险- 具体的干预措施，以最大限度地提高LTX的效益。本研究的应用将作为基础 显著提高国家保护和维护移植人群健康的能力。

Adherence and Health Outcomes after Liver Transplantation The goal of this R01 application is to determine the extent to which patient factors impact on adherence and health outcomes after liver transplantation (LTX). Transplantation is the only option for survival of end stage iver disease; demand far exceeds supply yet little is known about which patients benefit most from the procedure. There are clear links between treatment adherence and health outcomes both in general medicine and in other transplant patient populations. Determining which LTX patients are at risk of non- adherence and suboptimal health outcomes is an ongoing dilemma for clinicians and a significant public health issue; failure to do so is costly to the healthcare system and society. The proposed research will be the first known prospective study of adherence to the multifaceted LTX regimen. Specific aims of this longitudinal study are to 1) prospectively characterize adherence to medication taking, appointment keeping, and recommendedlifestyle changes over the first post-txpyear and identify latent classesof adherence trajectories; 2) determine salient individual and environmental factors that underlie variation in adherence and predict health outcomes. Adherence will be tracked with interviews, electronic medication monitors, and medical records review over the first year; individual and environmental patient factors will be assessedwith self report measures and interviews at 1-2, 6, and 12 months post-transplant; morbidity and, secondarily, mortality will be trackedwith medical records review over the remainder of the study period. This study will be conducted in collaboration with the Thomas E. Starzl Institute, at the University of PittsburghMedical Center; all adult recipients who survive the acute post-transplant period will be eligible. Recruitment will occur over a 2.5 year period and sample size is projected to be approximately 300 recipients. The long-term goal of this project is to develop guidelines for transplant clinicians to identify patients prior to or early after transplantation who are at risk of non-adherence and sub-optimal health outcomes for targetedpatient- specific interventions to maximize benefit of LTX. The application of this research would serve as the basis to advance significantly the nation's capacity to protect and preserve health in transplant populations.