Optimizing Testosterone Prescribing in the VA

优化退伍军人事务部的睾酮处方

基本信息

批准号：
10186475
负责人：
Guneet Jasuja
金额：
--
依托单位：
EDITH NOURSE ROGERS MEMORIAL VETERANS HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-03-01 至 2022-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10186475
关键词：
Acute Address Age Antibiotics Appropriateness Review Area Attitude Behavior Cardiovascular system Caring Characteristics Clinical Complex Data Databases Deimplementation Development Doctor of Philosophy Drug Prescriptions Education Effectiveness Formularies Fostering Foundations Future Gel Goals Growth Guidelines HIV Health Health Services Hypogonadism Institute of Medicine (U.S.)Intervention Interview Knowledge Label Letters Light Literature Marketing Medical Mental Depression Mentors Mentorship Methodology Methods Modeling Myocardial Infarction Outcome Outpatients Patients Pattern Perception Pharmaceutical Preparations Pharmacologic Substance Physical Function Physicians Policies Prostate Provider Publishing Qualitative Methods Qualitative Research Quality of Care Reporting Research Research Methodology Research Personnel Research Proposals Research Training Resources Respiratory Tract Infections Risk Safety Sales Scientist Site Stroke Structure System Testing Testosterone Time Training United States Food and Drug Administration Variant Veterans Visit Wages Work adverse outcome base career development cost cost efficient design effective intervention experience flexibility health care service organization implementation research improved insight interest male men mortality risk multi-component intervention pharmacy benefit public health relevance skills testosterone replacement therapy therapy design therapy development tool

项目摘要

DESCRIPTION (provided by applicant): This is the second submission of a VA HSR&D CDA proposal to provide five years of salary support to Guneet K. Jasuja, PhD toward her goal of becoming a VA independent investigator and expert on medication prescribing research. Dr. Jasuja is a research health scientist in the HSR&D Center for Healthcare Organization and Implementation Research (CHOIR). This proposal delineates the research and training objectives that will lead to Dr. Jasuja's maturation into an independent health services researcher while contributing to the quality of care for Veterans. The first aim is to elucidate quantitative patient-, provider-, and site-level predictor of potentially inappropriate testosterone prescribing that to date have not been explored. Analyses will be conducted using administrative data on all male Veteran patients without HIV, who had at least one outpatient visit and one prescription fill during FY08-FY14. We will apply Generalized Linear Mixed Models to examine our putative predictors at the patient- (e.g. depression), provider- (e.g. older age) and site-level (e.g. academic affiliation). The second aim is to examine patient, provider, and key opinion leader perceptions and system-level factors that relate to testosterone prescribing, using qualitative methods. For this study, we will conduct semi- structured interviews with patients, providers, and site-level thought leaders to gain additional insight into how their perceptions, as well as site factors, may influence testosterone prescribing. To effect meaningful change in prescribing, the results of the first two research aims will be combined with relevant findings in the literature to develop and pilot test a multi-faceted intervention to promote appropriate use of testosterone in the VA. The research proposed here will improve quality of care by limiting testosterone therapy to those patients most likely to benefit and least likely to be harmed. Investigating the context of testosterone prescribing and factors that contribute to suboptimal prescribing practices would be an important preparatory step before designing and implementing interventions to optimize testosterone therapy for those men in whom it is medically indicated. Findings from these studies will yield heretofore unknown information about several key aspects of potentially inappropriate testosterone prescribing, enabling future HSR&D research proposals to address similar medication prescribing issues. Lessons learnt from this study will also serve as an exemplar for other medications, which embody similar characteristics, including high cost and potential safety issues. In conjunction with the proposed research aims, the CDA will address key training objectives that will further develop Dr. Jasuja's research capabilities. These training objectives will provide formal and hands-on education in qualitative and implementation research methods. The carefully chosen mentorship team, selected for their knowledge and experience in the methodologies and content areas addressed in the proposal, is dedicated to fostering Dr. Jasuja's successful transition to an independent investigator. Drs. Rose and Bhasin have an established working relationship as current mentors on Dr. Jasuja's VISN 1 CDA, and Drs. Bokhour and Gifford have provided guidance and advice for several years. All are committed to the career development of Dr. Jasuja and the need for protected research time, as described in their attached letters. CHOIR has also committed resources to accomplish the objectives in the proposal. Dr. Jasuja's initial contribution will be to understand the factors that contribute to variation and overuse in testosterone across VA. In the long term, she will apply these skills more generally to the issue of reducing variation and overuse in other areas of care. The long-term outcome will be significant improvements in safe, effective, and high-quality medication prescribing to reduce adverse outcomes for Veterans.

描述（由申请人提供）：这是VA HSR＆D CDA提案的第二次提议，该提议为Guneet K. Jasuja提供五年的薪水支持，以成为她成为VA独立研究者和药物处方研究专家的目标。 Jasuja博士是HSR＆D医疗保健组织与实施研究中心（合唱团）的研究健康科学家。该提案描述了研究和培训目标，这将导致Jasuja博士成熟成为独立的健康服务研究人员，同时为退伍军人的护理质量做出了贡献。第一个目的是阐明潜在不适当的睾丸激素规定的定量患者，提供者和现场级别的预测指标，迄今为止尚未探讨该预测。分析将使用所有没有艾滋病毒的男性退伍军人患者进行的行政数据，他们在2014财年至少有一次门诊就诊和一份处方填充。我们将采用广义的线性混合模型来检查我们的推定预测因素，例如（例如抑郁症），提供者 - （例如，年龄较大）和现场级别（例如，学术分支机构）。第二个目的是检查使用定性方法，患者，提供者和关键意见领导者的看法和与睾丸激素处方有关的系统级因素。在这项研究中，我们将对患者，提供者和现场思想领导者进行半结构化访谈，以获得对他们的看法以及现场因素如何影响睾丸激素处方的更多见解。为了实现处方的有意义的变化，前两个研究的结果将与文献中的相关发现结合起来，以开发和试点测试是多方面的干预措施以促进VA中适当使用睾丸激素。此处提出的研究将通过将睾丸激素治疗限制为最有可能受益且最可能受到伤害的患者来提高护理质量。在设计和实施干预措施之前，研究睾丸激素处方的环境和有助于次优的规定实践的因素将是重要的准备步骤，以优化医学上指示的男性的睾丸激素治疗。这些研究的发现将产生有关潜在不适当睾丸激素处方的几个关键方面的迄今未知信息，从而使未来的HSR＆D研究建议可以解决类似的药物处方问题。从这项研究中学到的经验教训还将作为其他药物的典范，这些药物体现了类似特征，包括高成本和潜在的安全问题。结合拟议的研究目的，CDA将解决关键的培训对象，以进一步发展Jasuja博士的研究能力。这些培训对象将提供定性和实施研究方法的正式和动手教育。精心挑选的心态团队是为了在提案中涉及的方法和内容领域中的知识和经验而被选中，致力于促进Jasuja博士的成功过渡到独立研究者。 Rose和Bhasin博士在Jasuja博士的Visn 1 CDA和Drs博士的现任导师中建立了工作关系。 Bokhour和Gifford已提供了几年的指导和建议。如附件中所述，所有人都致力于Jasuja博士的职业发展以及对受保护的研究时间的需求。合唱团还承诺资源来实现提案中的目标。 Jasuja博士的最初贡献是了解导致VA睾丸激素变异和过度使用的因素。从长远来看，她将更普遍地应用这些技能，以减少其他护理领域的变化和过度使用问题。长期的结果将是安全，有效和高质量的药物规定，以减少退伍军人的不利结果。