STorytelling to Improve DiseasE outcomes in GoUT: The STRIDE-GO Study

讲故事可改善痛风的疾病结果：STRIDE-GO 研究

• 批准号: 10179468
• 负责人: Jasvinder A Singh
• 金额: --
• 依托单位: BIRMINGHAM VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-01 至 2022-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10179468
• 关键词: Accident and Emergency department; Achievement; Acute; Address; Adherence; Adoption; Affect; African; African American; Alcohol consumption; Area; Blood Pressure; Body mass index; Caring; Caucasians; Chronic; Chronic Disease; Chronic Obstructive Airway Disease; Client satisfaction; Clinic; Clinical; Clinical Trials; Communication; Computers; Congestive Heart Failure; Cues; Data; Databases; Development; Disease; Disease Outcome; Disease susceptibility; Effectiveness; Event; Flare; Foundations; Funding; Gout; Health; Hospitalization; Hospitals; Hypertension; Inflammatory Arthritis; Inpatients; Interruption; Intervention; Intervention Studies; Intuition; Knowledge; Lead; Measures; Medical Care Costs; Methods; Mission; Modeling; Modification; Monitor; Nature; Outcome; Pain; Patient Self-Report; Patient-Focused Outcomes; Patients; Pharmaceutical Preparations; Philadelphia; Pilot Projects; Psychological reinforcement; Publishing; Randomized; Randomized Controlled Trials; Research; Research Priority; Risk; Serum; Severity of illness; Site; Solid; Surveys; Symptoms; System; Target Populations; Technology; Telephone; Testing; Time; Treatment Efficacy; Urate; Veterans; Visit; Voice; attentional control; base; communication theory; comparative efficacy; cost; disability; efficacy testing; health belief; health care delivery; health care disparity; health care service utilization; health disparity; health related quality of life; improved; improved outcome; insight; intervention effect; joint destruction; medication compliance; novel; patient engagement; patient oriented; patient-level barriers; persistent symptom; primary outcome; programs; research study; secondary outcome; stress management; success; therapy adherence; touchscreen; treatment as usual; treatment guidelines

 DESCRIPTION (provided by applicant): Background and Objective: Low medication adherence in chronic diseases is a problem that costs over $100 billion a year in excess hospitalizations in the US. Patients often do not perceive disease severity and susceptibility to disease complications in chronic symptomatic diseases such as Chronic Obstructive Pulmonary disease (COPD), Congestive Heart Failure (CHF), gout, etc., since severe disease symptoms are intermittent. Our objective is to test the efficacy of a patient-centered, culturally relevant, narrative intervention, or "storytelling", basd on the solid conceptual foundation of the narrative communication theory and the Health Belief Model to improve medication adherence and outcomes in chronic diseases among African- American veterans, using gout as a test case. African-Americans (AAs) with gout have lower adherence to gout medications compared to Caucasians. Funded by the Veterans Affairs (VA) HSR&D pilot study program, we have completed the development and iterative modification of a powerful "storytelling" intervention consisting of messages from AA veterans with higher ULT adherence at Birmingham, AL and Philadelphia, PA. This final intervention has been tested for feasibility, acceptability, content and narrative strength in the target population at these sites and endorsed to be powerful by the target population. Project Objectives and Aims: Our long-term objective is to reduce health disparities in veterans and improve their health outcomes. The objective of the proposed study is to assess the efficacy of a novel storytelling intervention in veterans' own voices to improve medication adherence and patient outcomes in African- American veterans with gout. Our Specific Aim (SA)s are to assess the efficacy of storytelling intervention in African-American veterans with gout for improving: SA1: Improving ULT adherence, directly measured by using MEMS (Medication Event Monitoring System) Caps at 3, 6 and 9 months (assess intervention's effect) and 12 months (assess durability of effect), SA2: Improving Gout flare rate, patient satisfaction and target serum urate (sUA) <6 mg/dl achievement, as indirect measures of better ULT adherence and important gout outcomes. Project Methods: We will conduct a 12-month, multicenter, randomized controlled trial among 250 African- American veterans with gout with ULT medication possession ratio of <80% at Birmingham, St. Louis and Philadelphia VA clinics. We will compare the efficacy of the storytelling intervention to usual care in improving ULT adherence, assessed with MEMSCaps (electronic monitoring) at 6-months (primary outcome); reducing gout flares needing treatment, improving patient satisfaction, improving the ability to achieve target serum urate <6 mg/dl and improving self-reported ULT adherence at 6-months (secondary outcomes). We will assess these outcomes at 12-months as evidence for sustenance of the effect of intervention. Alignment with VA mission and priorities: This study serves the VA's mission of improving the health of veterans and addresses two priority areas, 1) decreasing health care disparities and 2) improving health care delivery using a low-cost, technology-based solution to poor medication adherence. Study results will lead to a ready-to-implement low cost patient-centered intervention for AA veterans with gout to improve medication adherence and patient outcomes. Our study will provide the proof of efficacy of "storytelling" for improving medication adherence in chronic symptomatic diseases. The "storytelling" intervention can be easily adapted for similar chronic symptomatic conditions such as COPD and CHF.

 描述（由申请人提供）： 背景和目的：慢性疾病的药物依从性低是一个问题，在美国，患者每年因过度住院而造成的费用超过 1000 亿美元。慢性阻塞性肺病等慢性症状性疾病的严重程度和并发症的易感性。慢性阻塞性肺病 (COPD)、充血性心力衰竭 (CHF)、痛风等，因为严重的疾病症状是间歇性的，我们的目标是测试以患者为中心、文化相关的叙述性干预或治疗的效果。 “讲故事”，基于叙事沟通理论和健康信念模型的坚实概念基础，以患有痛风的非裔美国人（AA）为测试案例，以改善非裔美国退伍军人慢性病的药物依从性和结果。与白人相比，痛风药物的依从性较低 在退伍军人事务部 (VA) HSR&D 试点研究项目的资助下，我们已经完成了强大的“讲故事”干预措施的开发和迭代修改，该干预措施包括来自 AA 退伍军人的信息阿拉巴马州伯明翰和宾夕法尼亚州费城的最终干预措施已在这些地点的目标人群中进行了可行性、可接受性、内容和叙述强度的测试，并得到了目标人群的认可：我们的项目目标和目的。长期目标是减少退伍军人的健康差异并改善他们的健康结果。拟议研究的目的是评估一种新颖的讲故事干预退伍军人自己的声音的效果，以提高非裔美国退伍军人的药物依从性和患者预后。我们的具体目标(SA) 将评估讲故事干预对患有痛风的非裔美国退伍军人的改善效果： SA1：提高 ULT 依从性，通过使用 MEMS（药物事件监测系统）在 3、6 和 9 个月时直接测量上限（评估干预的效果）效果）和 12 个月（评估效果的持久性），SA2：改善痛风发作率、患者满意度和目标血清尿酸 (sUA) <6 mg/dl 实现，作为间接衡量更好的 ULT 依从性和重要的痛风结果 项目方法：我们将在伯明翰、圣路易斯和弗吉尼亚州费城对 250 名 ULT 药物持有率 <80% 的非裔美国退伍军人进行一项为期 12 个月的多中心随机对照试验。我们将比较讲故事干预与常规护理在提高 ULT 依从性方面的功效，并在 6 个月时使用 MEMSCaps（电子监测）进行评估（主要结果）；满意度，提高实现目标血清尿酸<6 mg/dl 的能力，并提高 6 个月时自我报告的 ULT 依从性（次要结果）。我们将在 12 个月时评估这些结果，作为维持干预效果的证据。与 VA 任务优先事项保持一致：本研究服务于 VA 改善退伍军人健康的使命，并解决两个优先领域：1) 减少医疗保健差距；2) 使用低成本、基于技术的方法改善医疗保健服务研究结果将导致对患有痛风的 AA 退伍军人实施低成本的以患者为中心的干预措施，以改善药物依从性和患者结果，我们的研究将为改善“讲故事”的功效提供证据。慢性症状性疾病的药物依从性“讲故事”干预可以很容易地适用于类似的慢性症状性疾病，如慢性阻塞性肺病和慢性心力衰竭。

项目成果

SToRytelling to Improve Disease outcomes in Gout (STRIDE-GO): a multicenter, randomized controlled trial in African American veterans with gout.

SToRytelling 改善痛风疾病结局 (STRIDE-GO)：一项针对患有痛风的非裔美国退伍军人进行的多中心、随机对照试验。

• 发表时间: 2021-11-09
• 影响因子: 9.3
• 作者: Singh, Jasvinder A;Joseph, Amy;Baker, Joshua;Richman, Joshua S;Shaneyfelt, Terrence;Saag, Kenneth G;Eisen, Seth
• 通讯作者: Eisen, Seth

Management of Rheumatic Diseases During the COVID-19 Pandemic: A National Veterans Affairs Survey of Rheumatologists.

COVID-19 大流行期间风湿病的管理：全国退伍军人事务风湿病学家调查。

• 发表时间: 2021
• 影响因子: 4.7
• 作者: Singh, Jasvinder A;Richards, John S;Chang, Elizabeth;Joseph, Amy;Ng, Bernard
• 通讯作者: Ng, Bernard

SToRytelliing to Improve Disease outcomes in Gout (STRIDE-GO) in African American veterans with gout: a trial study protocol.

SToRytelling 改善患有痛风的非裔美国退伍军人的痛风疾病结果 (STRIDE-GO)：一项试验研究方案。

• 发表时间: 2021-12-04
• 影响因子: 2.5
• 作者: Singh; Jasvinder A
• 通讯作者: Jasvinder A