Improving Medication Adherence for Osteoporosis:Community Based Randomized Con

提高骨质疏松症的药物依从性：基于社区的随机对照

• 批准号: 7578202
• 负责人: Daniel Hal Solomon
• 金额: $ 39.48万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-04-01 至 2012-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7578202
• 关键词: Adherence; Adult; Age; Aging; Anatomic Sites; Caring; Clinical Research; Collaborations; Communities; Contracts; Costs and Benefits; Data; Drug usage; Economics; Effectiveness; Effectiveness of Interventions; Elderly; End Point; Enrollment; Fracture; Funding; Healthcare; Hip Fractures; Hospitals; Intervention; Investigation; Knowledge; Language; Literature; Low income; Measures; Mediating; Medical; Methods; Osteoporosis; Osteoporosis prevention; Outcome; Patients; Pennsylvania; Pharmaceutical Economics; Pharmaceutical Preparations; Pharmacoepidemiology; Pharmacologic Substance; Pharmacotherapy; Physicians; Predisposition; Preventive; Public Health; Quality-Adjusted Life Years; Randomized; Randomized Controlled Trials; Range; Rate; Research; Resolution; Resources; Risk; Self Efficacy; System; Testing; Upper arm; Woman; base; beneficiary; compliance behavior; cost; cost effectiveness; experience; falls; improved; medication compliance; multidisciplinary; prescription document; prescription procedure; prevent; programs; theories

Osteoporosis is morbid, mortal, and costly. Approximately 1 in 4 adults who sustain a hip fracture experience a permanent loss of independence and 15-25% die in the subsequent year. Many fractures could be prevented through preventive measures, from better practice of fall reduction strategies to targeted use of effective pharmacotherapy. However, few patients at-risk for fractures from osteoporosis use drugs for osteoporosis persistently. We, and many others, have documented sub-optimal use of these drugs. Several theory-based large-scale public health trials by our group suggest that rates of treatment initiation can be improved through a combined approach targeting both patients and their physicians. We urgently need to develop methods for improving adherence with osteoporosis treatments. To this end, we propose a cluster randomized controlled trial (RCT) to improve adherence with drugs for osteoporosis. This proposal builds on several decades of research by our group to improve medication use and 5 years of focused investigations on improving osteoporosis care. As well, we utilize a long-term collaboration between the Brigham and Women's Hospital (BWH) Division of Pharmacoepidemiology and Pharmacoeconomics and the Pennsylvania Pharmaceutical Assistance Contract for the Elderly (PACE). Aim 1) Conduct a cluster RCT to test patient- and physician-targeted interventions combined with a systems approach to improve adherence with medications for osteoporosis. We will enroll new users of medications for osteoporosis in a three arm RCT - control, patient intervention, and combined patient and physician interventions. The trial will focus on improving the following outcomes: 1) adherence with osteoporosis medications; 2) intermediate outcomes hypothesized to mediate the effects of the intervention on adherence (such as resolution of barriers to adherence, patient's osteoporosis knowledge, perceived susceptibility, and self-efficacy); and 3) the rates of fracture. Aim 2) Calculate the cost-effectiveness of the cluster RCT conducted in Aim 1. Using data from the trial conducted in Aim 1, we will calculate the costs and benefits of the intervention and determine the potential cost per fracture averted. Many of the assumptions for this analysis will be derived from Aim 1, and several regarding the effectiveness of drugs in reducing fractures will be literature-based. Appropriate sensitivity analyses will allow for estimation of cost and benefits under a variety of scenarios. Lay Language: Osteoporosis is morbid, mortal, and costly. Effective treatments are not used persistently by patients. We will test an intervention to improve medication adherence in a large group of at-risk older adults. The economic implications of the intervention will also be analyzed.

骨质疏松症是病态，致命和昂贵的。大约有四分之一的人维持髋部骨折 在接下来的一年中，经历永久性独立丧失和15-25％的死亡。许多断裂 可以通过预防措施来防止秋季减少策略的更好实践 使用有效的药物疗法。但是，很少有骨质疏松症骨折的患者使用药物 对于骨质疏松症持续存在。 We, and many others, have documented sub-optimal use of these drugs. Several theory-based large-scale public health trials by our group suggest that rates of treatment initiation 可以通过针对患者及其医生的组合方法来改进。我们紧急 需要开发改善骨质疏松症治疗的方法。 为此，我们提出了一项群集随机对照试验（RCT），以提高使用药物的依从性 骨质疏松症。该建议建立在我们小组的数十年研究基础上，以改善药物使用 以及5年以改善骨质疏松护理的重点研究。同样，我们长期使用 Brigham和妇女医院（BWH）药物ePidemiology和 老年人（PACE）的药物经济学和宾夕法尼亚州的药物援助合同。 目标1）进行集群RCT，以测试患者和医师的干预措施，并结合 使用骨质疏松症的药物来改善依从性的系统方法。 我们将在三个ARM RCT，患者干预，患者干预，患者干预中，将新的用于骨质疏松症的药物注册 and combined patient and physician interventions.该试验将着重于改善以下结果： 1）遵守骨质疏松药物； 2）假设介导效果的中间结果 依从性的干预（例如遵守障碍的解决方案，患者的骨质疏松症 知识，感知的敏感性和自我效能）； 3）断裂率。 目标2）计算在AIM 1中进行的群集RCT的成本效益。 使用AIM 1中的试验数据，我们将计算干预的成本和收益 确定避免裂缝的潜在成本。该分析的许多假设将得出 来自AIM 1，以及有关药物在减少骨折中的有效性的一些，将是基于文献的。 适当的灵敏度分析将允许在各种情况下估算成本和收益。 外行语言：骨质疏松症是病态，致命和昂贵的。 Effective treatments are not used persistently by 患者。 We will test an intervention to improve medication adherence in a large group of at-risk older 成年人。干预的经济影响也将进行分析。