Increasing Autonomous Motivation in ESRD to Enhance Phosphate Binder Adherence

描述(由申请人提供)：终末期肾病(ESRD)患者的高磷血症是全因和心血管死亡的非传统危险因素。在ESRD患者中，不坚持使用磷酸盐粘合剂的比例高达74%，并已被证明与包括态度在内的心理社会因素最相关。关于这一现象的影响的数据有限 态度和自主支持对磷酸盐粘合剂的依从性和这两个心理社会结构可以通过使用动机访谈技巧来增加自主动机而产生积极的影响。此外，已知ESRD患者存在种族差异，在理解ESRD易感患者依从性差异的决定因素方面仍存在差距。PI在100名流行的透析患者中进行了一项初步研究，结果显示，积极的态度与更高的粘合剂用药依从性相关(p=0.04)，用药依从性与血清磷水平相关(p&lt；0.001)。更大的自主性支持与更好的药物依从性(p=0.017)和更好的磷控制相关，并注意到种族的细微潜在差异。这项建议的首要目标是让PI通过确定激励性访谈对不同ESRD患者的磷酸盐结合物依从性的影响来获得关键的研究经验和技能。通过这个项目，临床研究所将在研究设计、实施、分析和研究结果的传播方面获得宝贵的研究经验，这些将有效地为作为一名以患者为中心的临床研究人员的成功职业生涯奠定基础。PPI概述了一项培训计划，其中包括通过公共卫生计划进行系统的研究培训；有指导的研究经验；参加地方和国家研究会议/会议，并积极参与创新和极其支持的研究环境。这项拟议的奖项将有助于PI获得以患者为导向的临床研究方面的经验和全面培训，以(A)成功获得职业发展研究奖，以解决肾脏疾病中的差异，并最终为独立资助的研究职业生涯奠定基础，通过领导行为临床试验、测试新颖的多层次策略并将其转化为临床治疗，识别和克服护理方面的差距。

DESCRIPTION (provided by applicant): Hyperphosphatemia in end-stage renal disease (ESRD) patients is a non-traditional risk factor for all-cause and cardiovascular mortality. Non-adherence to phosphate binders is as high as 74% in ESRD patients and has been shown to be most related to psychosocial factors including attitudes. There is limited data on the influence of attitudes and perceived autonomy support on phosphate binder adherence and these two psychosocial constructs can be positively influenced through the use of motivational interviewing skills to increase autonomous motivation. Furthermore, racial disparities are known to exist in ESRD however and there are still gaps, which exist in understanding the determinants of disparities in adherence in vulnerable patients with ESRD. The PI conducted a pilot study in100 prevalent dialysis patients, which revealed that positive attitudes correlated with higher binder medication adherence (p=0.04) and medication adherence correlated with serum phosphorus levels (p<0.001). Greater perceived autonomy support was associated with both better medication adherence (p=0.017) and better phosphorus control and subtle underlying differences by race were noted. The overarching objective of this proposal is for the PI to gain critical research experience and skills by determining the impact of motivational interviewing on phosphate binder adherence in diverse ESRD patients. Through this project, the PI will gain valuable research experience in study design, implementation, analysis and dissemination of research findings, and these will effectively set the foundation for a successful career as a patient-oriented clinical investigator. The PI has outlined a training plan that integrates structured research training through the MPH Program; a mentored research experience; participation in local and national research meetings / conferences and active involvement in an innovative and extremely supportive research environment. This proposed award will facilitate the PI to gain experience and comprehensive training in patient-oriented clinical research to (a) successfully obtain a career development research award to address disparities in kidney disease and ultimately to (b) set the stage for an independently funded research career identifying and overcoming gaps in care by leading behavioral clinical trials testing novel multi-level strategies and translating them to clinical care.