Developing a provider-facing intervention to address cost-related medication restrictions and improve medication use in patients with type 2 diabetes

制定面向医疗服务提供者的干预措施，以解决与费用相关的药物限制并改善 2 型糖尿病患者的药物使用

• 批准号: 10569117
• 负责人: Jing Luo
• 金额: $ 18.81万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-01 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10569117
• 关键词: Academic Detailing; Address; Adherence; Agonist; Award; Cardiovascular Diseases; Cardiovascular system; Clinical; Cluster randomized trial; Code; Community Practice; Complement; Cost Sharing; Data; Databases; Deductibles; Development Plans; Diabetes Mellitus; Drug Prescriptions; Education and Outreach; Educational workshop; Effectiveness; Enrollment; Event; Formularies; Foundations; Funding; GLP-I receptor; Glucose; Glucose Transporter; Goals; Guidelines; Health; Health Insurance; Health Personnel; Health system; Insurance Carriers; Intervention; Interview; Knowledge; Measures; Medical; Medicare; Medicine; Mentors; Mentorship; Methods; Modeling; National Institute of Diabetes and Digestive and Kidney Diseases; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Patient-Focused Outcomes; Patients; Pharmaceutical Preparations; Policies; Price; Process; Provider; Recommendation; Reporting; Research; Research Personnel; Risk; Risk Factors; Risk Reduction; Sodium; Structure; Testing; Training; Training Activity; Transcript; acceptability and feasibility; barrier to care; basal insulin; burnout; cardiovascular disorder risk; cardiovascular risk factor; career; career development; clinical outcome measures; cohort; copayment; cost; design; evidence base; experience; follow-up; improved; inhibitor; medication compliance; mortality; pilot test; poor health outcome; primary care provider; primary care setting; prior authorization; recruit; theories

Project Summary/Abstract The prescribing of, and adherence to, glucose-lowering medications is increasingly being driven by health insurance factors such as high out-of-pocket medication costs and formulary practices that restrict use (e.g. requirements for prior authorization). These types of cost-related medication restrictions (defined as high copayments, high deductibles, formulary restrictions) can limit appropriate use of evidence-based medications, especially when formularies lag behind a rapidly evolving evidence base. For example, recent evidence suggests that SGLT-2 inhibitors and GLP-1 receptor agonists reduce the risk of cardiovascular disease (CVD) events and mortality in patients with type 2 diabetes and elevated CV risk. If cost-related medication restrictions limit the use of evidence-based, guideline recommended therapies in these patients, it may ultimately result in worse health outcomes. Such policies can also increase administrative burden for the practitioner and contribute to provider burnout. The goal of this proposal is to develop a provider-facing intervention to address cost-related restrictions and improve medication use for patients with type 2 diabetes. It has 3 specific aims: 1) To examine the association between cost-related medication restrictions and initiation of, and adherence to, newer 2nd line glucose-lowering medications among patients with type 2 diabetes (T2D) with and without established CVD, 2) To describe the cost-related restrictions experienced by health care providers seeking to prescribe glucose-lowering medications, and how they respond to such restrictions in contemporary practice and 3) To develop and pilot test a provider-facing, educational outreach intervention to help address cost-related restrictions and improve the optimal use of glucose lowering medications. These aims will be complemented by a career development plan that incorporates didactic coursework, participation in workshops, and intensive mentorship under an outstanding team led by Dr. Walid Gellad, an R01-funded investigator with a track record of successfully mentoring K awardees. The plan fills important gaps in the PI’s training and will generate pilot data to form the basis of a follow-up R01 application testing whether a provider- facing educational outreach intervention can improve the evidence-based use of glucose lowering medications and clinical outcomes for patients with type 2 diabetes.

项目概要/摘要 降糖药物的处方和依从性越来越受到健康的驱动 保险因素，例如高额自付费用和限制使用的处方做法（例如 这些类型的与费用相关的药物限制（定义为高）。 共付额、高免赔额、处方限制）可能会限制循证药物的适当使用， 尤其是当处方集落后于快速发展的证据基础时，例如，最近的证据。 表明 SGLT-2 抑制剂和 GLP-1 受体激动剂可降低心血管疾病 (CVD) 的风险 2 型糖尿病患者的事件和死亡率以及与药物费用相关的心血管风险升高。 这些限制限制了这些患者使用基于证据的指南推荐的治疗方法，可能 这些政策最终会导致更糟糕的健康结果，还会增加政府的行政负担。 该提案的目标是开发一个面向提供商的系统。 旨在解决与费用相关的限制并改善 2 型糖尿病患者药物使用的干预措施。 有 3 个具体目标：1) 检查与费用相关的药物限制和启动之间的关联 2 型糖尿病 (T2D) 患者对新二线降糖药物的使用和依从性 有或没有已确定的 CVD，2) 描述医疗保健所经历的与成本相关的限制 寻求开降血糖药物的提供者，以及他们如何应对此类限制 当代实践和 3) 开发并试点测试面向提供者的教育外展干预措施 帮助解决与成本相关的限制并改善降糖药物的最佳使用。 目标将得到职业发展计划的补充，其中包括教学课程、参与 参加研讨会，并在由 R01 资助的 Walid Gellad 博士领导的杰出团队的指导下进行深入指导 该计划填补了 PI 的重要空白。 培训并将生成试点数据，以构成后续 R01 应用测试的基础 接受教育外展干预可以改善降糖药物的循证使用 以及 2 型糖尿病患者的临床结果。