IS NON-ADHERENCE A REVEALED PREFERENCE

不遵守是一种显性偏好吗

• 批准号: 6382848
• 负责人: LESLIE A. LENERT
• 金额: $ 34.36万
• 依托单位: VETERANS MEDICAL RESEARCH FDN/SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2001
• 资助国家: 美国
• 起止时间: 2001-06-01 至 2004-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6382848
• 关键词: AIDS therapy; behavioral /social science research tag; cardiovascular disorder chemotherapy; clinical research; health behavior; health care service evaluation; health services research tag; human subject; hypertension; interview; preference; therapy compliance

Non-adherence to medications is a ubiquitous problem that is incompletely understood. It increases costs and wastes valuable resources. In hypertension, non-adherence places patients at risk of stroke and heart disease. In Human Immunodeficiency Virus (HIV) infection, non-adherence not only leads to progression of disease, but also threatens to overturn the hard-won advances by facilitating the breeding of resistant strains of HIV. The goal of this study is to further understanding of the root causes of non-adherence through the study of preferences. Our central hypothesis is that when a patient is non-adherent, it is often the result of his or her judgment that the overall cost-to-benefit ratio of proper use of a medication is unfavorable. Widely applied behavioral models of non-adherence, such as the Health Belief Model, typically acknowledge the central role of a patient's weighing of the risks and benefits in his or her subsequent adoption of desired health-behaviors. However, most previous research in this area has applied relatively crude methods to measure the perceived benefit of adherence. In this study, we will take a detailed look at the components of risk-benefit judgements using computer interviews to measure the utility of adherence and other aspects of preferences. We will then determine the relationship between the utility of adherence and medication use behavior. Most models of adherence recognize the influence of factors such as ethnicity, drug abuse, and perceived vulnerability to disease and on health behaviors. Many of these factors may be mediated through effects on preferences. Therefore, this study will also examine associations among demographic, psychosocial factors and patients' utility scores for health outcomes. The design of the study is a cross-sectional survey with longitudinal follow up. Studies will be conducted in two patient groups (HIV and hypertension) in order to assess the generalizability of findings to other populations. Data on patients' preferences will be collected using the standard gamble, time trade-off, and other utility metrics (including risk attitude) for favorable and unfavorable life courses with high and low adherence efforts and moderate and low adverse effects. We will then estimate the marginal disutility of adherence from these multi-attribute measures. Other data to be collected include demographic factors, psychosocial factors, and estimates of the effects of adherence on the probability of complications. The explanatory power of demographic and psychosocial factors and utilities will be compared using logistic regression and CART. We will also use an expert panel to assess the clinical match between patients' regimens and their preferences.

不遵守药物是一个无处不在的问题，尚未完全理解。它增加了成本并浪费了宝贵的资源。在高血压中，不遵守使患者处于中风和心脏病的风险。在人类免疫缺陷病毒（HIV）感染中，不仅依从性不仅导致疾病的发展，而且威胁着通过促进抗HIV抗性菌株的繁殖来推翻硬胜的进步。这项研究的目的是通过研究偏好的研究进一步了解不遵守的根本原因。我们的中心假设是，当患者不遵守时，通常是由于他或她的判断，即正确使用药物的总体成本效益比是不利的。不遵守性的不遵守行为模型（例如健康信念模型）通常会承认患者权衡其随后采用所需健康状况的风险和福利的核心作用。但是，该领域的大多数研究都采用了相对粗略的方法来衡量依从性的感知益处。在这项研究中，我们将使用计算机访谈来详细了解风险效益判断的组成部分，以衡量依从性和偏好的其他方面的效用。然后，我们将确定依从性和用药使用行为之间的关系。大多数依从性模型都认识到种族，药物滥用以及对疾病和健康行为的脆弱性等因素的影响。这些因素中的许多因素可以通过对偏好的影响来介导。因此，这项研究还将研究人口，心理因素和患者的效用评分之间的关​​联。该研究的设计是一项横断面调查，并进行了纵向随访。研究将在两个患者组（HIV和高血压）中进行，以评估发现对其他人群的普遍性。将使用标准赌博，时间权衡和其他公用事业指标（包括风险态度）来收集有关患者偏好的数据，以实现有利和不利的生活课程，并具有较高和低的依从性工作以及中等和低的不利影响。然后，我们将估算这些多物种措施的依从性的边际分离。要收集的其他数据包括人口统计学因素，社会心理因素以及依从性对并发症可能性的影响的估计。人口统计学和社会心理因素和公用事业的解释能力将使用逻辑回归和购物车进行比较。我们还将使用专家小组来评估患者方案及其偏好之间的临床匹配。