Barriers to Optimal Cardiovascular Medication Use in Diabetes and Renal Disease

糖尿病和肾病患者最佳使用心血管药物的障碍

• 批准号: 7664406
• 负责人: Uptal D Patel
• 金额: $ 12.52万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-09-25 至 2011-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7664406
• 关键词: Address; Adverse effects; Adverse reactions; Angiotensin Receptor; Angiotensin-Converting Enzyme Inhibitors; Angiotensins; Aspirin; Attitude; Award; Awareness; Blood Pressure; Cardiac; Cardiovascular Diseases; Cardiovascular system; Caring; Chronic Kidney Failure; Clinic; Clinical Investigator; Clinical Research; Clinical Trials Design; Coronary heart disease; Diabetes Mellitus; Disease; Elderly; Event; Failure; Focus Groups; Future; Glomerular Filtration Rate; Goals; Health system; Hypersensitivity; Intervention; K-Series Research Career Programs; Kidney Diseases; Knowledge; Laboratories; Lead; Link; Master' s Degree; Measurement; Mentorship; Outcome; Oxidoreductase; Patient Care; Patients; Peripheral arterial disease; Pharmaceutical Preparations; Physicians; Population; Preventive; Provider; Randomized Controlled Trials; Relative (related person); Renal function; Reporting; Research Personnel; Risk; Risk Factors; Secondary Prevention; Subgroup; Surveys; System; Training; Translating; abstracting; cardiovascular disorder risk; career; career development; clinical care; design; evidence based guidelines; heart disease risk; high risk; improved; inhibitor/antagonist; insight; meetings; mortality; multidisciplinary; programs; research study; response

DESCRIPTION (provided by applicant): Large quality gaps exist between scientifically proven therapies and the care that is actually delivered. My long term career goals are to 1) generate the knowledge to fill such quality deficits by identifying the relevant barriers and 2) design and implement quality improvement (Ql) interventions that address those barriers. Diabetes mellitus (DM) and chronic kidney disease (CKD) are both coronary heart disease risk equivalents and associated with increased mortality, primarily due to cardiovascular disease (CVD). Paradoxically, patients with DM and CKD are at greatest risk yet less likely to receive CVD-preventive medications: underutilization of such medications (aspirin, angiotensin antagonists, and statins) is widespread. The reasons why 20-40% of these high-risk patients do not receive these beneficial therapies are not known. Potential barriers at the physician, patient, and systems-levels include: physician knowledge and attitudes, kidney function measurement factors, medication related factors, competing demands and prioritization, and organizational factors. For this career development award, we will determine which physician, patient, and organizational barriers actually limit the delivery of adequate CVD-preventive medications. Through focus groups of patients and physicians within 2 health systems and 6 clinics, we will develop patient chart review and physician survey instruments. The charts of 1,250 patients with DM and CKD will be abstracted and their physicians will be surveyed. The patient, physician, and system-level predictors of suboptimal prescribing will be explored through bivariate and multilevel analyses by linking patients' outcomes (i.e. CVD medication prescriptions) to providers' survey responses. We will also determine the maximum achievable utilization rates of the-3 CVD medication groups at different levels of kidney function; information important for quality assessment and designing future studies to improve prescribing. Findings from these studies will provide the knowledge necessary to design a Ql intervention that is tailored to overcome the specific barriers identified. To gain proficiency in trial design and implementation, the career development components of this Award include completion of a Masters degree in Clinical Research and superb multidisciplinary mentorship. Combined with the proposed research studies, this training will allow me to become an independent clinical investigator who is well-poised to make significant contributions to the care of patients with CKD.

描述（由申请人提供）： 科学证明的疗法与实际提供的护理之间存在较大的质量差距。我的长期职业目标是1）通过确定相关障碍以及2）设计和实施解决这些障碍的质量改进（QL）干预来产生知识来填补此类质量缺陷。糖尿病（DM）和慢性肾脏疾病（CKD）都是冠心病风险等效物，并且与死亡率增加有关，这主要是由于心血管疾病（CVD）。矛盾的是，患有DM和CKD的患者的风险最大，但接受CVD预防药物的可能性较小：这种药物的利用不足（阿司匹林，血管紧张素拮抗剂和汀类药物）广泛。这些高危患者中有20-40％未接受这些有益疗法的原因。医师，患者和系统级别的潜在障碍包括：医师知识和态度，肾脏功能测量因素，相关因素，竞争要求和优先次序以及组织因素。对于这个职业发展奖，我们将确定哪些医师，患者和组织障碍实际上限制了足够的CVD预防药物的提供。通过2个卫生系统和6个诊所中的患者和医师的焦点小组，我们将开发患者图表审查和医师调查工具。将抽象1,250例DM和CKD患者的图表，并将调查其医生。通过将患者的结果（即CVD药物处方）与提供者的调查反应联系起来，将通过双变量和多层次分析来探讨次优处方的患者，医师和系统级别的预测指标。我们还将确定在不同水平的肾脏功能下的3 CVD药物组的最大可实现利用率；信息对于质量评估和设计未来的研究至关重要，以改善处方。这些研究的发现将提供设计QL干预所必需的知识，该干预措施是为了克服所确定的特定障碍而定制的。为了熟练掌握试验设计和实施，该奖项的职业发展组成部分包括完成临床研究硕士学位和超级学科指导。结合拟议的研究，该培训将使我成为一名独立的临床研究者，他对CKD患者的护理做出了重大贡献。