Trajectories of Adherence to Cardiovascular Medications in Patients on Dialysis

透析患者心血管药物的依从轨迹

• 批准号: 8804807
• 负责人: Jenny I Shen
• 金额: $ 18.24万
• 依托单位: LUNDQUIST INSTITUTE FOR BIOMEDICAL INNOVATION AT HARBOR-UCLA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-16 至 2020-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8804807
• 关键词: Adherence; Adrenergic beta-Antagonists; Age; American; Angiotensin II Receptor; Angiotensin-Converting Enzyme Inhibitors; Asians; Attitude; Belief; Calcium Channel Blockers; Cardiovascular Agents; Cardiovascular Diseases; Cardiovascular system; Cause of Death; Cessation of life; Clinical; Clinical Sciences; Conflict (Psychology); Data; Data Analyses; Development; Dialysis patients; Dialysis procedure; Drops; Economic Factors; Effectiveness; End stage renal failure; Epidemiology; Ethnic Origin; Ethnic group; Event; Exhibits; Health; Health Services Research; Hispanics; Information Systems; Institutes; Intervention; Interview; Kidney; Knowledge; Life; Maintenance; Master' s Degree; Measures; Medicare; Medicine; Mentors; Methods; Minority; Minority Groups; Modeling; Myocardial Infarction; Not Hispanic or Latino; Outcome; Patients; Pattern; Pharmaceutical Preparations; Population; Population Heterogeneity; Qualitative Research; Race; Research; Research Methodology; Research Personnel; Resources; Risk; Stroke; Structure; Testing; Time; Training; Translational Research; Variant; Work; adverse outcome; base; copayment; experience; improved; innovation; medication compliance; mortality; named group; patient oriented; patient population; pill; primary outcome; public health relevance; socioeconomics; tool development

 DESCRIPTION (provided by applicant): The purpose of this K23 proposal is to provide Jenny Shen, MD, MS with the protected time and resources to pursue the training needed to become an independent patient-oriented researcher. Dr. Shen is a board- certified nephrologist with a Master's Degree in Epidemiology. Her research focuses on improving outcomes in patients receiving dialysis, particularly those from racial and ethnic minorities. Cardiovascular (CV) disease is the leading cause of death among patients on maintenance dialysis. While CV medications are a mainstay of treatment, the evidence for their effectiveness in this special population is conflicting. We hypothesize that differences in the trajectories of longer-term adherence to CV medications might explain the variation seen in clinical outcomes for dialysis patients prescribed CV drugs. We propose to determine which trajectories of adherence are associated with the best outcomes and to understand why these different trajectories exist. Our study has three specific aims: 1) to identify trajectories and correlates of longer-term adherence to CV medications in patients initiating dialysis; 2) to assess the relationships among different trajectories of longer-term adherence to CV outcomes in patients receiving dialysis, and to test if these relationships are modified by race and ethnicity; and 3) to describe and compare the experiences, knowledge, and beliefs about longer-term medicine-taking over time and across various racial and ethnic groups receiving dialysis. We will use data from the U.S. Renal Data System, including Medicare Part D prescription claims data. Aim 1 will employ an innovative method of group-based trajectory models to classify patients by their pattern of adherence to CV medications in the first year after dialysis initiation. Aim 2 will use multivariable time-to-event analyses to assess the association between the different patterns of adherence and CV events. Aim 3 will involve serial semi-structured interviews conducted over the course of the patient's first year of maintenance dialysis. Results from the proposed work has the potential to decrease the burden of CV disease in the dialysis population by informing the creation of culturally competent interventions aimed at improving longer-term adherence to CV medications in racially and ethnically diverse populations of patients undergoing dialysis. It will also utilize te resources of the UCLA Clinical and Translational Science Institute to provide the mentored training and experience in advanced quantitative methods of longitudinal data analysis, qualitative research methods, and health services research focused on minorities that will enable the applicant to successfully become an independent, patient-oriented researcher.

 描述（由申请人提供）：本 K23 提案的目的是为医学博士、理学硕士 Jenny Shen 提供受保护的时间和资源，以接受成为一名独立的以患者为导向的研究员所需的培训。Shen 博士是经过委员会认证的。拥有流行病学硕士学位的肾脏病学家，她的研究重点是改善接受透析的患者的预后，特别是少数族裔的患者。心血管 (CV) 疾病是维持治疗患者死亡的主要原因。虽然心血管药物是治疗的主要方法，但其在这一特殊人群中的有效性证据是相互矛盾的，长期坚持使用心血管药物的轨迹差异可能解释了透析患者临床结果的变化。我们建议确定哪些依从性轨迹与最佳结果相关，并了解为什么存在这些不同的轨迹：1）确定长期依从性的轨迹和相关性。开始透析的患者的药物治疗；2) 评估接受透析的患者长期坚持心血管结果的不同轨迹之间的关系，并测试是否 这些关系会因种族和民族而变化；3) 描述和比较接受透析的不同种族和民族群体的长期用药经验、知识和信念。数据系统，包括 Medicare D 部分处方索赔数据，目标 1 将采用基于组的轨迹模型的创新方法，根据透析开始后第一年的 CV 药物依从性模式对患者进行分类，目标 2 将使用多变量。事件发生时间 目标 3 将涉及在患者维持性透析第一年期间进行的系列半结构化访谈，以评估不同依从性模式与心血管事件之间的关联。拟议工作的结果有可能减轻患者的负担。通过告知制定文化上有效的干预措施，旨在提高不同种族和民族的透析患者对心血管药物的长期依从性，该计划还将利用加州大学洛杉矶分校临床和转化科学的资源。研究所提供纵向数据分析的高级定量方法、定性研究方法和针对少数群体的健康服务研究方面的指导培训和经验，使申请人能够成功成为一名独立的、以患者为导向的研究人员。