The Effects of Visit Characteristics on Patient-Clinician Interactions and Health Outcomes in Knee Osteoarthritis

就诊特征对膝骨关节炎患者与临床医生互动和健康结果的影响

• 批准号: 10735706
• 负责人: Michelle L Dossett
• 金额: $ 80.43万
• 依托单位: UNIVERSITY OF CALIFORNIA AT DAVIS
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2028-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10735706
• 关键词: Adult; Adverse event; Affect; Age; Arousal; Arthritis; Behavior; Behavioral; Biochemical Pathway; Catechols; Characteristics; Chronic; Clinical; Clinical Trials; Communication; Degenerative polyarthritis; Diclofenac; Elderly; Elements; Galvanic Skin Response; Gel; Genetic; Genetic Polymorphism; Genotype; Goals; Health; Heartburn; High Prevalence; Individual; Knee Osteoarthritis; Length; Literature; Measures; Mediating; Medical; Mission; Outcome; Pain; Patient-Focused Outcomes; Patients; Pharmaceutical Preparations; Physical Function; Physiological; Physiology; Placebo Effect; Play; Polypharmacy; Population; Public Health; Publishing; Randomized; Research; Ritual compulsion; Role; Safety; Science; Self Efficacy; Smiling; Testing; Therapeutic Effect; Topical application; Transferase; Treatment outcome; Visit; Western Ontario and McMaster Universities Arthritis Index; Work; aging population; care delivery; chronic pain; chronic pain management; clinical care; clinically relevant; common treatment; conditioning; design; disability; ethnic diversity; health communication; heart rate variability; impression; improved; improved outcome; indexing; innovation; insight; knee pain; older patient; osteoarthritis pain; pain catastrophizing; pain reduction; patient expectation; patient oriented; provider behavior; racial diversity; randomized trial; response; standard of care; symptomatic improvement; treatment effect

Project Summary/Abstract Non-specific/non-pharmacologic therapeutic effects can improve health outcomes, however, little is known about how to maximize these effects, particularly for effects related to patient-clinician interactions. These effects are especially important in treating chronic pain. Preliminary studies indicate that both increased visit length and augmented visit content (designed to elicit a holistic understanding of the individual) enhance non- specific effects related to patient-clinician interactions, but it is unclear which of these factors is more important or if their interaction is synergistic. This proposal’s long-term goal is to advance the science of non-specific therapeutic effects related to patient-clinician interactions to improve health outcomes. Its objective is to quantify the relative effects of, and mechanisms by which, increased visit length and augmented visit content affect patient-clinician interactions and health outcomes in knee osteoarthritis (OA). Knee OA is an ideal condition for studying the effects of visit length and content on patient-clinician interactions and health outcomes because it is a leading cause of chronic pain and disability in older adults, many common treatments have poor safety profiles, and clinical trials of medications for knee OA suggest that non-specific therapeutic effects account for a major component of treatment effects. The central hypothesis is that both increased visit length and augmented visit content will increase the non-specific treatment effects associated with diclofenac gel (a standard topical treatment for knee OA-related pain). Project specific aims are: 1) To determine whether increased visit length and/or augmented visit content increase the non-specific treatment effects of diclofenac gel on knee OA pain and function; 2) To determine how visit length and content affect patient and clinician behaviors and physiology during patient-clinician interactions; and 3) To determine whether patient COMT genotype modifies the effects of increased visit length and augmented visit content on knee pain. The approach is innovative in that there are few randomized trials targeting non-specific effects associated with patient- clinician interactions, and none that directly test the effects of visit length and content on health outcomes or use physiologic measures to assess patient-clinician interactions. The proposed study is significant because it will determine the relative contributions of visit length and content on health outcomes in knee OA and advance understanding of potential clinical, behavioral, physiologic, and genetic mechanisms through which non- specific effects impact health outcomes. This project advances a line of research focused on improving outcomes in knee OA by developing and testing strategies to modify clinical care delivery to maximize non- specific therapeutic effects associated with patient-clinician interactions. It will also help develop new research approaches for studying patient-clinician interactions. Insights gained from this project will also be relevant to other chronic and painful conditions, may help reduce polypharmacy among older adults, and will advance understanding of the roles of non-specific therapeutic effects in health outcomes.

项目概要/摘要 非特异性/非药物治疗作用可以改善健康结果，但人们知之甚少 关于如何最大化这些影响，特别是与患者与临床医生互动相关的影响。 初步研究表明，增加就诊次数对于治疗慢性疼痛尤为重要。 长度和增强的访问内容（旨在引发对个人的整体了解）增强非 与患者与临床医生互动相关的具体影响，但尚不清楚这些因素中哪一个更重要 或者它们的相互作用是否具有协同作用。该提案的长期目标是推进非特异性科学。 与患者与临床医生互动相关的治疗效果，以改善健康结果。 量化增加访问时间和增加访问内容的相对影响和机制 影响膝骨关节炎 (OA) 患者与临床医生的互动和健康结果 膝关节 OA 是一种理想的治疗方法。 研究就诊时长和内容对患者与临床医生互动和健康影响的条件 因为它是老年人慢性疼痛和残疾的主要原因，许多常见的治疗方法 安全性较差，膝关节骨关节炎药物的临床试验表明，非特异性治疗 效果是治疗效果的一个主要组成部分，核心假设是两者都增加了就诊次数。 长度和增加的访问内容将增加与双氯芬酸相关的非特异性治疗效果 凝胶（膝关节骨关节炎相关疼痛的标准局部治疗） 项目的具体目标是： 1) 确定是否有效。 增加就诊时间和/或增加就诊内容会增加双氯芬酸的非特异性治疗效果 膝盖 OA 疼痛和功能凝胶；2) 确定就诊时间和内容对患者和临床医生的影响 患者与临床医生互动期间的行为和生理学；以及 3) 确定患者是否 COMT 基因型改变了增加就诊时间和增加就诊内容对膝盖疼痛的影响。 其创新之处在于，很少有针对与患者相关的非特异性效应的随机试验 临床医生的互动，没有直接测试就诊时长和内容对健康结果或使用的影响 评估患者与临床医生相互作用的生理措施很重要，因为它将。 确定就诊时长和内容对膝关节 OA 健康结果的相对贡献并提前 了解潜在的临床、行为、生理和遗传机制，通过这些机制，非 该项目推进了一系列旨在改善健康结果的研究。 通过制定和测试策略来修改临床护理服务以最大限度地提高非膝关节炎的治疗效果 与患者与临床医生互动相关的特定治疗效果也将有助于开展新的研究。 从该项目中获得的见解也将与研究患者与临床医生互动的方法相关。 其他慢性和疼痛性疾病，可能有助于减少老年人的多重用药，并将促进 了解非特异性治疗效果在健康结果中的作用。