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: 9085817
• 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 2021-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9085817
• 关键词: Accident and Emergency department; Accident and Emergency department; Achievement; Achievement; Acute; Acute; Address; Address; Adherence; Adherence; Adoption; Adoption; Affect; Affect; African; African; African American; African American; Alcohol consumption; Alcohol consumption; Area; Area; Attention; Blood Pressure; Blood Pressure; Body mass index; Body mass index; Caring; Caring; Caucasians; Caucasians; Chronic; Chronic; Chronic Disease; Chronic Disease; Chronic Obstructive Airway Disease; Chronic Obstructive Airway Disease; Client satisfaction; Client satisfaction; Clinic; Clinic; Clinical; Clinical; Clinical Trials; Clinical Trials; Communication; Communication; Computers; Computers; Congestive Heart Failure; Congestive Heart Failure; Cues; Cues; Data; Data; Databases; Databases; Development; Development; Disease; Disease; Disease Outcome; Disease Outcome; Disease susceptibility; Disease susceptibility; Effectiveness; Effectiveness; Electronics; Equilibrium; Event; Event; Flare; Flare; Foundations; Foundations; Funding; Funding; Gout; Gout; Guidelines; Health; Health; Hospitalization; Hospitalization; Hospitals; Hospitals; Hypertension; Inflammatory Arthritis; Inflammatory Arthritis; Inpatients; Inpatients; Interruption; Intervention; Intervention; Intervention Studies; Intervention Studies; Intuition; Knowledge; Knowledge; Lead; Lead; Measures; Measures; Medical Care Costs; Medical Care Costs; Methods; Methods; Mission; Mission; Modeling; Modeling; Modification; Modification; Monitor; Monitor; Nature; Nature; Outcome; Outcome; Pain; Pain; Patient Self-Report; Patient Self-Report; Patient-Focused Outcomes; Patient-Focused Outcomes; Patients; Patients; Pharmaceutical Preparations; Pharmaceutical Preparations; Philadelphia; Philadelphia; Pilot Projects; Pilot Projects; Psychological reinforcement; Psychological reinforcement; Publishing; Publishing; Randomized; Randomized; Randomized Controlled Trials; Randomized Controlled Trials; Research; Research; Research Priority; Research Priority; Risk; Risk; Serum; Serum; Severity of illness; Severity of illness; Site; Site; Solid; Solid; Surveys; Surveys; Symptoms; Symptoms; System; System; Target Populations; Target Populations; Technology; Technology; Telephone; Telephone; Testing; Testing; Time; Time; Treatment Efficacy; Treatment Efficacy; Urate; Urate; Veterans; Veterans; Visit; Visit; Voice; Voice; attentional control; base; base; communication theory; communication theory; comparative efficacy; comparative efficacy; cost; cost; disability; disability; efficacy testing; efficacy testing; health belief; health belief; health care delivery; health care delivery; health care disparity; health care disparity; health care service utilization; health care service utilization; health disparity; health disparity; health related quality of life; health related quality of life; improved; improved; improved outcome; improved outcome; insight; insight; intervention effect; intervention effect; joint destruction; joint destruction; medication compliance; medication compliance; novel; novel; patient engagement; patient oriented; patient oriented; patient-level barriers; persistent symptom; persistent symptom; primary outcome; primary outcome; programs; programs; research study; research study; secondary outcome; secondary outcome; stress management; stress management; success; success; therapy adherence; therapy adherence; touchscreen; touchscreen; treatment as usual; 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）： 背景和目标：慢性疾病中的药物依从性低是美国每年超过1000亿美元的过期住院费用的问题。由于严重的疾病症状是间歇性的，患者通常不会感知疾病的严重程度和对慢性症状疾病（例如慢性阻塞性肺部疾病（COPD），充血性心力衰竭（CHF），GET等）中疾病并发症的易感性。我们的目标是测试以患者为中心的，文化相关的，叙事的干预措施或“讲故事”的有效性，这是叙事交流理论的稳固概念基础以及健康信念模型，以改善非洲裔美国退伍军人的慢性疾病的药物依从性和慢性疾病的结果，以痛苦的态度为病例。与高加索人相比，具有脱身的非裔美国人（AAS）对脱身药物的依从性较低。由退伍军人事务（VA）HSR＆D试点研究计划资助，我们已经完成了由AA退伍军人的信息组成的强大“讲故事”干预措施的开发和迭代修改，该信息在伯明翰，AL和Pharadelphia，宾夕法尼亚州伯明翰和费城较高的最终依从性。这项最终干预已经过测试，以确保这些地点的目标人群的可行性，可接受性，内容和叙事强度，并由目标人群认可。项目目标和目标：我们的长期目标是减少退伍军人的健康差异并改善其健康成果。拟议的研究的目的是评估退伍军人自己声音中新的讲故事干预的有效性，以改善通过goout的非洲裔美国退伍军人的药物依从性和患者结果。 Our Specific Aim (SA)s are to assess the efficiency of storytelling intervention in African-American veterans with goout 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: Improved Gout flare rate, patient satisfaction and target serum urate (sUA) <6 MG/DL成就，作为更好的最终依从性和重要结果的间接测量。项目方法：我们将在250名非裔美国退伍军人中进行12个月的多中心随机对照试验，其最终药物潜在比率在伯明翰，圣路易斯和费城VA诊所<80％。我们将将讲故事干预的效率与通常的护理在改善最终依从性方面的效率，并在6个月（主要结果）下对MEMSCAPS（电子监测）进行评估；减少痛风的耀斑需要治疗，提高患者满意度，提高实现目标连续尿素<6 mg/dl的能力，并在6个月（次要结果）上提高自我报告的Ult依从性。我们将在12个月的时间内评估这些结果，以此作为可持续干预影响的证据。与VA任务和优先事项的一致性：本研究符合VA的使命，即改善退伍军人的健康并解决两个优先领域，1）减少医疗保健分配； 2）使用基于低成本的基于技术的解决方案来改善医疗保健服务，以解决较差的药物依从性。研究结果将导致AA退伍军人以患者为中心的成本低成本的干预，以改善药物依从性和患者预后。我们的研究将提供“讲故事”的效率证明，以改善慢性症状疾病的药物依从性。 “讲故事”干预很容易适应类似的慢性症状疾病，例如COPD和CHF。