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。据估计，50%的慢性病药物治疗患者在六个月后难以坚持他们的方案。这导致更差的临床结果和增加的医疗保健利用率和成本。在关节炎和肌肉骨骼疾病中，粘附性差的后果尚未得到很好的研究。痛风是检查缺乏依从性的理想条件，因为它影响多达500万美国人，并且其发病率正在上升。长期使用降尿酸药物（ULD）可以有效治疗慢性痛风，这些药物相对便宜，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ULD。课程和提案中概述的一系列项目将使Harrold博士获得必要的培训和经验，成为一名独立的研究人员，进行研究，改善为风湿性疾病患者提供的护理。拟议研究的总体目标是通过开发促进依从性的干预措施，为理解ULD依从性做出实质性的科学贡献。本研究的具体目的是：1）调查痛风患者不依从ULD的发生率，并确定不依从的风险因素; 2）确定导致不依从的患者、提供者和系统因素; 3）评估不依从ULD对临床和成本结果的影响; 4）开发和试点测试教育和电话咨询干预措施，以促进ULD的依从性。现有的管理数据将进行分析，以评估谁是ULD的新用户之间的痛风患者的依从性，并描述个人谁是不遵守的患者，供应商和卫生系统的特点。将进行深入的患者和提供者访谈，以探讨不依从的原因。将使用问卷调查和管理数据比较依从患者与非依从患者，前瞻性检查不依从对临床结局和痛风相关医疗利用的影响。最后，一个教育和电话咨询干预，旨在促进遵守与ULD将开发和试点。这项工作将为随后的R 01应用提供关键经验和试验数据。

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.