Patient Navigators: Secondary Prevention in Underserved Coronary Disease Patients

患者导航：服务不足的冠心病患者的二级预防

• 批准号: 8079731
• 负责人: Diane M. Becker
• 金额: $ 52.78万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-29 至 2013-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8079731
• 关键词: Address; Adherence; Adrenergic beta-Antagonists; African American; Age; American; American Heart Association; Aspirin; Behavior; Behavioral; Biological; Blood Platelets; Blood Pressure; Blood Vessels; C-reactive protein; Cardiac; Cardiology; Cardiovascular system; Caring; Case Fatality Rates; Cessation of life; Characteristics; Chemoprophylaxis; Chronic Disease; Clinical Trials Design; Complex; Control Groups; Coronary Arteriosclerosis; Coronary Artery Bypass; Coronary heart disease; Data; Diagnostic; Dilatation - action; Disease Outcome; Education; Educational Background; Educational Status; Ethnic Origin; Event; Failure; Female; Funding; Goals; Health; Health Services Accessibility; Health Status; Hospitalization; Hospitals; Household; Hyperemia; Hypotension; Improve Access; Individual; Inflammatory; Insurance; Insurance Coverage; Interleukin-6; Intervention; Interview; LDL Cholesterol Lipoproteins; Life; Link; Lipids; Low income; Maintenance; Malignant Neoplasms; Mediating; Medical; Morbidity - disease rate; Myocardial Infarction; Nature; Operative Surgical Procedures; Outcome; Patient Discharge; Patients; Personal Satisfaction; Pharmaceutical Preparations; Pharmacotherapy; Physical activity; Pilot Projects; Platelet Activation; Platelet Factor 4; Preventive; Primary Health Care; Provider; Proxy; Publishing; Questionnaires; Randomized; Randomized Controlled Clinical Trials; Randomized Controlled Trials; Recommendation; Recurrence; Regimen; Resources; Risk Factors; Secondary Prevention; Services; Social support; Socioeconomic Status; Solutions; Source; Specific qualifier value; System; Techniques; Testing; Time; Underserved Population; Uninsured; age effect; bone; brachial artery; cancer care; college; contextual factors; coronary angioplasty; cytokine; design; disorder prevention; follow-up; improved; innovation; mortality; outreach; payment; pill; programs; sex; skills; socioeconomics; treatment as usual

DESCRIPTION (provided by applicant): Although statins, aspirin, and beta blocker therapy together markedly reduce recurrent coronary artery disease (CAD) events and cardiovascular death and are the mainstay of nationally recommended CAD secondary prevention, these agents remain seriously underutilized in underserved populations. Post-hospitalization CAD case fatality rates are significantly higher in patients from underserved backgrounds, attributed in part to failure to be able to afford, access, and adhere to preventive pharmacotherapy. Complex systems that assure payment for medications are known to be difficult to navigate, particularly for underserved populations. Patient navigators (PN) have been shown to improve access to care and improve outcomes in cancer care in underserved populations. Preliminary data from our randomized Pilot Study of PN in 46 underserved CAD patients show improved medication access and risk factor outcomes in the group randomized to the PN compared with enhanced usual care. We thus propose a larger randomized controlled trial of PN versus EUC in 360 (51% Black American, 26% female) low income or low educational level CAD patients discharged from the hospital without any medication insurance coverage. In the EUC "control" group, providers are given information about how to access resources whereas in the PN group, the PN interacts with patients regularly using guided interviews. The specific aims are to compare the impact of the PN vs EUC at 6 and 12 months post CAD discharge on (1) the percent of patients who seek primary care follow-up, (2) adhere to beta-blocker, aspirin, and statin therapy, (3) reduce risk factors (LDL-cholesterol, diastolic and systolic blood pressure, inflammatory cytokines, platelet activation) and (4) demonstrate improved vascular health using brachial artery reactivity flow-mediated dilatation. The analyses will be carried out using GLM and/or GEE techniques. All multivariable analyses will be conducted adjusting for sex, nature of the CAD, age, social support variables, behaviors, education and socioeconomic status, in addition to the intervention contingency. This study offers a significant contribution toward the design of innovative ways to address disparities that persist in CAD outcomes in underserved populations. This application proposes a randomized controlled trial in low income or low educational level coronary disease patients discharged from the hospital without any medication insurance coverage with endpoints focused on (1) improvement in the percent of underserved patients who seek early primary care follow-up, (2) adherence to beta- blocker, aspirin, and statin therapy, (3) reduction in risk factors and (4) improvement in brachial artery reactivity flow-mediated dilatation as a proxy for improved vascular health.

描述（由申请人提供）：尽管他汀类药物，阿司匹林和β受体阻滞剂疗法共同减少了复发性冠状动脉疾病（CAD）事件和心血管死亡，并且是全国推荐的CAD二级预防的中流tay柱，但这些药物在不受欢迎的人群中仍然严重不足。在服务不足背景的患者中，院后CAD病例死亡率明显更高，部分原因是无法负担，进入并遵守预防药物治疗。已知确保药物支付的复杂系统很难导航，尤其是对于服务不足的人群而言。已显示患者导航员（PN）可改善服务不足人群的癌症护理的获得和改善。我们在46名服务不足的CAD患者中对PN的随机试点研究的初步数据显示，与增强的常规护理相比，该组随机分为PN的药物访问和危险因素结果得到了改善。因此，我们提出了360名PN与EUC的更大的随机对照试验（51％的黑人美国人，26％女性）低收入或从医院出院的低教育水平CAD患者而没有任何药物保险覆盖。在EUC“控制”组中，提供了有关如何访问资源的信息，而在PN组中，PN使用带导式访谈的患者与患者进行互动。具体目的是比较CAD出院后6和12个月在（1）寻求初级保健随访的患者百分比（（2）遵守β受体阻滞剂，阿司匹林和他汀类药物治疗的患者中，（3）减少危险因素（LDL-胆固醇，糖尿病和炎症，使用脑液体效率，（4动脉反应流介导的扩张。分析将使用GLM和/或GEE技术进行。除干预意外情况外，还将针对性别，年龄，社会支持变量，行为，教育和社会经济地位进行调整，以调整性别，年龄，社会支持变量，行为，教育和社会经济状况。这项研究为设计持续存在的差异的创新方式做出了重要贡献，这些差异持续存在。该申请提议在低收入或低教育水平的冠状动脉疾病患者中进行随机对照试验，而没有任何药物保险覆盖范围，其终点的重点是（1）改善（1）寻求初级保健随访的不足的患者百分比，（（2）对β-阻滞剂，阿司匹林和毒素治疗的降低（3）较低的疾病，（3）降低了（3）较低的（3）较低的（4）较低的（4）ARTARCITIAN（4）AIR（4）ARTARCITIAN RACTIAN AIR（4）AIR（4）AIR（4）AIR（4）ARTARCITIAN RACHITION ARINTIAN RACTIAN RACTIAN RACTIAN AIRTIAN AIR（4）AIR（4）。代理可改善血管健康的代理。