Understanding Oral Anticoagulation Use and Success Among Patients with Psychiatric Multimorbidity in Atrial Fibrillation

了解心房颤动精神多重病患者口服抗凝药的使用和成功

基本信息

批准号：
10321943
负责人：
Benita A Bamgbade
金额：
$ 16.2万
依托单位：
NORTHEASTERN UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-01-01 至 2025-12-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10321943
关键词：
Adherence Adult Adverse event Affect Anticoagulants Anticoagulation Anxiety Atrial Fibrillation Behavior Behavioral Bleeding time procedure Cardiovascular Diseases Caregivers Chronic Client satisfaction Clinical Clinical Skills Cohort Studies Communities Complement Complex Data Data Analyses Decision Making Diabetes Mellitus Diagnosis Disease Doctor of Pharmacy Doctor of Philosophy Dose Educational workshop Elderly Elements Event Family Focus Groups Funding Geriatric Assessment Goals Guidelines Health Health system Healthcare Hemorrhage Impaired cognition Intervention Knowledge Literature Medical Medical Records Mental Depression Mentored Research Scientist Development Award Mentors Mentorship Methods Monitor National Heart, Lung, and Blood Institute Oral Outcome Participant Patient Outcomes Assessments Patient-Focused Outcomes Patients Pharmaceutical Preparations Pharmacists Pharmacy facility Population Populations at Risk Prevalence Reporting Research Research Activity Research Methodology Research Personnel Risk Science Stroke Stroke prevention Symptoms Technical Expertise Therapeutic Time Training Treatment outcome Triad Acrylic Resin Universities Warfarin Woman Work career clinical care comorbidity design experience health difference health related quality of life high risk improved insight medication compliance multiple chronic conditions patient oriented professor programs protective factors response socioeconomics success symposium willingness

项目摘要

Project Summary My long-term career goal is to become an independent pharmacist researcher with expertise in psychiatric multimorbidity research in cardiovascular disease. Through my research program I aim to identify factors that influence the health and medication taking behaviors of older adults with psychiatric multimorbidity using “real world” observational data and direct patient and stakeholder engagement. I have clinical (PharmD) and graduate (PhD) training in pharmacy and I am an assistant professor at Northeastern University in the Department of Pharmacy and Health Systems Sciences. Training facilitated by this K01 award will help me achieve my long- term career goal by building on my clinical and technical skills as a pharmacist and researcher and providing me with the protected time necessary to expand my expertise in longitudinal data analysis, mixed methods and patient-centered research in cardiovascular disease and multimorbidity. I have assembled an outstanding, committed, and interdisciplinary team of nationally renowned experts in fields relevant to the proposed research and my long-term goals. My training plan complements my prior training and experience and incorporates interaction with mentors, formal coursework, hands-on training, workshops, conferences and research activities. Using a mixed methods design, my proposal seeks to build and expand on my preliminary work completed in partnership with the ongoing NHLBI funded study, Systematic Assessment of Geriatric Elements in Atrial Fibrillation (SAGE-AF). I will leverage observational data, currently being collected in SAGE-AF, to evaluate the longitudinal impact of psychiatric multimorbidity (i.e., dyads and the triad of depression, anxiety and cognitive impairment) on oral anticoagulant (OAC) use and outcomes in patients with atrial fibrillation (AF). I will examine relationships between psychiatric multimorbidity and clinical outcomes such as bleeding and medication adherence. I will also examine relationships between psychiatric multimorbidity and patient reported outcomes that are not readily available in the medical record but are increasingly important to patients, their families and clinicians such as patient satisfaction and health-related quality of life. Then, I will conduct focus groups of SAGE- AF participants (92% report willingness to continue in SAGE-AF) and stakeholders to understand protective factors that influence anticoagulation success among patients with psychiatric multimorbidity, including factors that are not evaluated in the SAGE-AF data. The specific aims are to: 1) Examine the relationship between psychiatric multimorbidity and OAC prescribing in AF; 2) Among OAC users, examine longitudinal associations between psychiatric multimorbidity and OAC success indicators and patient reported outcomes over 2 years; and 3) Conduct 6-8 qualitative focus groups including SAGE-AF participants, their caregivers and their clinicians, to identify factors that influence OAC success. This proposal aligns with NHLBI’s overarching objective 3 by investigating factors that account for differences in health among populations and has high potential to identify factors that can be useful targets for patient-centered interventions.

项目概要我的长期职业目标是成为一名具有精神科专业知识的独立药剂师研究员通过我的研究项目，我的目标是确定心血管疾病的多发病因素。使用“真实”影响患有精神多病的老年人的健康和服药行为世界”观察数据以及直接患者和利益相关者的参与我拥有临床（药学博士学位）和研究生。我是东北大学药学系助理教授 K01 奖项促进的药学和健康系统科学培训将帮助我实现我的长期目标通过建立我作为药剂师和研究员的临床和技术技能并为我提供长期职业目标有必要的保护时间来扩展我在纵向数据分析、混合方法和我在心血管疾病和多发病方面进行了以患者为中心的研究。由相关领域的国内知名专家组成的跨学科团队致力于拟议的研究我的培训计划补充了我之前的培训和经验，并纳入了我的长期目标。与导师的互动、正式课程、实践培训、研讨会、会议和研究活动。使用混合方法设计，我的提案旨在构建和扩展我在 2017 年完成的初步工作与正在进行的 NHLBI 资助的研究“心房老年要素的系统评估”合作我将利用目前在 SAGE-AF 中收集的观察数据来评估颤动。精神多病（即抑郁、焦虑和认知的二元组和三元组）的纵向影响我将研究房颤 (AF) 患者口服抗凝剂 (OAC) 使用和结果的影响。精神多发病与出血和药物治疗等临床结果之间的关系我还将研究精神科多重发病率与患者报告结果之间的关系。这些信息在医疗记录中不易获得，但对患者及其家人和患者来说越来越重要强如患者满意度和健康相关的生活质量然后，我将进行 SAGE 焦点小组-。 AF 参与者（92% 表示愿意继续参加 SAGE-AF）和利益相关者了解保护措施影响精神多重疾病患者抗凝成功的因素，包括因素 SAGE-AF 数据中未评估的具体目标是： 1) 检查之间的关系。 AF 中的精神多发病和 OAC 处方；2) 在 OAC 用户中，检查纵向关联精神科多重病态与 OAC 成功指标以及患者报告的 2 年结果之间的关系； 3) 举办 6-8 个定性焦点小组，包括 SAGE-AF 参与者、他们的护理人员和赞助人，确定影响 OAC 成功的因素该提案符合 NHLBI 的总体目标 3：调查导致人群健康差异的因素，并有很大潜力确定可以作为以患者为中心的干预措施的有用目标的因素。