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.

不坚持服药是一个普遍存在的问题，但尚未完全了解。它增加了成本并浪费了宝贵的资源。对于高血压，不遵守规定会使患者面临中风和心脏病的风险。在人类免疫缺陷病毒（HIV）感染中，不遵守规定不仅会导致疾病进展，而且还会促进艾滋病毒耐药株的繁殖，从而威胁到来之不易的进展。本研究的目的是通过偏好研究进一步了解不遵守的根本原因。我们的中心假设是，当患者不依从治疗时，通常是他或她判断正确使用药物的总体成本效益比不利的结果。广泛应用的不依从行为模型，例如健康信念模型，通常承认患者权衡风险和收益在他或她随后采取期望的健康行为中的核心作用。然而，该领域之前的大多数研究都采用相对粗糙的方法来衡量坚持的感知益处。在本研究中，我们将使用计算机访谈来详细研究风险收益判断的组成部分，以衡量依从性和偏好其他方面的效用。然后我们将确定依从性的效用和药物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、对疾病的脆弱性和健康行为等因素的影响。其中许多因素可能是通过影响偏好来调节的。因此，本研究还将研究人口统计学、社会心理因素和患者对健康结果的效用评分之间的关​​联。该研究的设计是一项横断面调查和纵向随访。研究将在两个患者群体（艾滋病毒和高血压）中进行，以评估研究结果对其他人群的普遍性。将使用标准赌博、时间权衡和其他效用指标（包括风险态度）来收集患者偏好的数据，以获取有利和不利的生命历程，以及高和低的依从性努力以及中和低的不良影响。然后，我们将根据这些多属性测量来估计依从性的边际负效用。需要收集的其他数据包括人口因素、社会心理因素以及依从性对并发症概率影响的估计。将使用逻辑回归和 CART 来比较人口统计和社会心理因素以及效用的解释力。我们还将聘请专家小组来评估患者的治疗方案与其偏好之间的临床匹配度。