Enhancing treatment adherence and health outcomes

描述(由申请者提供)：本提案请求支持一项新的博士后培训计划，以培训医学博士和博士研究人员在开发有关坚持治疗和慢性病管理的创新、高影响力研究方面发挥领导作用，以改善患有儿科慢性病的儿童的健康结果。现代医疗改善了大量患有慢性病的儿童和青少年的健康状况。然而，在儿童对慢性病的终生管理过程中，改善他们的健康结果的最关键的剩余障碍之一是不遵守处方治疗。不依从性被定义为处方治疗(药物或其他治疗)与患者实际服用的药物之间的差异。正如世界卫生组织(世卫组织)所指出的那样，不坚持治疗不仅非常普遍(在儿科慢性病人群中的比率为50%或更高)，而且对儿童的健康和医疗保健费用产生了非同寻常的负面影响。将需要创新和临床相关的研究，以缩小通过更优化的治疗依从性可能实现的健康结果与当前实践所实现的健康结果之间的差距。NIH计划的优先顺序和申请请求、科学共识会议和学术综述都确定了儿科治疗依从性研究的关键重要性。在儿科依从性和慢性病管理研究方面取得科学进展的一个关键障碍是缺乏有才华、训练有素的研究人员，他们致力于在儿科人群中开发创新、高影响的治疗依从性和慢性病管理研究。解决这一需求和改善儿童健康的最有希望的方法之一是开发创新的跨学科研究培训计划，以培训治疗依从性和慢性病管理研究领域的领导者。这就是拟议计划的目标。具体的培训创新将涉及生物医学、行为、生物统计学和卫生服务/结果研究的整合，并反映在全面的培训课程和研究机会中。研究创新包括采用技术(远程医疗、互联网、手机)促进坚持干预的新方法，旨在增强干预效果的力量和持续时间，并接触到无法轻松获得传统临床方法的不同人群。项目创新还将通过新的研究培训机会来加强，以评估儿科慢性病管理中依从性促进干预措施的相对有效性，整合依从性测量的客观方法(例如，行为和药理学)，并进行先进的统计分析，以评估依从性促进干预措施对儿童健康结果的影响。

DESCRIPTION (provided by applicant): This proposal requests support for a new postdoctoral training program to train MD and PhD researchers to assume leadership roles in developing innovative, high impact research on adherence to medical treatment and chronic illness management that will enhance the health outcomes of children with pediatric chronic conditions. Modern medical treatments have improved the health outcomes of large numbers of children and adolescents with chronic conditions. However, one of the most critical remaining barriers to improving children's health outcomes over the course of their lifetime management of chronic illness is nonadherence to prescribed medical treatment. Nonadherence is defined as the discrepancy between prescribed treatment (medication or other treatments) and what is actually taken by patients. As noted by the World Health Organization (WHO), treatment nonadherence is not only highly prevalent (rates of 50% or greater in pediatric chronic illness populations) but has an extraordinary negative impact on children's health and health care costs. Innovative and clinically relevant research will be needed to close the gap between the health outcomes that are potentially achievable with more optimal treatment adherence and those achieved in current practice. NIH program priorities and requests for applications, scientific consensus conferences, and scholarly reviews have all identified the critical importance of research on pediatric adherence to treatment. A critical barrier to scientific advances in pediatric adherence and chronic illness management research is the shortage of talented, well-trained researchers who are devoting their careers to developing innovative, high impact treatment adherence and chronic illness management research with pediatric populations. One of the most promising ways to address this need and improve child health is to develop innovative interdisciplinary research training programs to train leaders in the field of treatment adherence and chronic illness management research. This is the goal of the proposed program. Specific training innovations will involve the integration of biomedical, behavioral, biostatistics, and health services/outcomes research and are reflected in a comprehensive training curriculum and research opportunities. Research innovations include novel methods of adherence promotion interventions involving technology (telehealth, internet, cell phone) designed to enhance the power and duration of intervention effects and reach diverse populations who cannot easily access traditional clinic-based approaches. Program innovation will also be enhanced by novel research training opportunities to evaluate the comparative effectiveness of adherence promotion interventions in pediatric chronic illness management, to integrate objective methods of adherence measurement (e.g., behavioral and pharmacological) and conduct advanced statistical analyses to evaluate the impact of adherence promotion interventions on children's health outcomes.