Improving medication adherence and disease control for patients with multimorbidity: the role of price transparency tools

提高多病患者的药物依从性和疾病控制：价格透明度工具的作用

基本信息

批准号：
10591441
负责人：
Caroline Ellen Sloan
金额：
$ 18.69万
依托单位：
DUKE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-01-01 至 2027-12-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10591441
关键词：
Academic Medical Centers Address Adherence Adopted Affect Assessment tool Award Caring Cessation of life Characteristics Chronic Clinical Clinics and Hospitals Colorado Complex Cost-Sharing Insurance Data Decision Making Dedications Development Diabetes Mellitus Disease Progression Dose Drug Prescriptions Elderly Electronic Health Record Environment Evaluation Financial Support Foundations Frequencies General Population Geography Glycosylated hemoglobin A Goals Health Services Health system Healthcare Hospitalization Improve Access Institution Internist Intervention Interview Mediating Medical Medicare Mentored Patient-Oriented Research Career Development Award Mentors Mentorship Methods Outcome Patient-Focused Outcomes Patients Pattern Perception Pharmaceutical Preparations Pharmacy facility Policies Policy Analysis Price Privatization Program Evaluation Reporting Research Research Personnel Retrospective cohort study Role Site Structure Subgroup Time Training United States Centers for Medicare and Medicaid Services Universities acceptability and feasibility aged barrier to care career comorbidity cost cost estimate design diabetes control disorder control effectiveness evaluation electronic health record system experience high risk implementation tool improved insurance plan medication compliance middle age multiple chronic conditions novel older patient patient population primary care provider tool uptake usability virtual

项目摘要

Dr. Sloan is a general internist and health services researcher whose long-term career goal is to evaluate the effectiveness of policies and interventions that address barriers to care for older adults with multimorbidity. Many patients with multimorbidity struggle to pay for their medications. These patients have lower medication adherence, resulting in a higher risk of disease progression, functional limitations, hospitalization, and death. Patients cannot account for medication costs in their medical decisions, because they rarely know what those costs will be before getting to the pharmacy. If clinicians could access information about their patients’ medica- tion-related out-of-pocket costs at the point-of-prescribing, they could help their patients apply for financial sup- port, or prescribe lower-cost alternatives. New out-of-pocket drug price transparency tools could fill this need. The Centers for Medicare and Medicaid Services recently mandated that Medicare Part D plans make clinician- facing out-of-pocket drug price transparency tools available to clinics and hospitals via the electronic health record (EHR). No one has described the uptake and acceptability of these tools, or their impact on clinical out- comes among middle-aged and older patients with multimorbidity. The goal of this K23 award is to evaluate how primary care providers at one large academic health system use a widely available price transparency tool and how price transparency at the point-of-prescribing affects clinical outcomes for middle-aged and older patients with multimorbidity. This health system’s price transparency tool, adopted in 2019, is compatible with all Medicare plans and ~95% of private insurance plans in its state. In Aims 1 and 2, Dr. Sloan will describe the uptake and acceptability of the price transparency tool using an ex- planatory sequential mixed methods design. In Aim 1, she will conduct an EHR-based retrospective cohort study of ~700 clinicians and ~140,000 patients aged >50 with multimorbidity to determine the clinician and patient factors associated with use. In Aim 2, she will conduct ~24 semi-structured interviews to explore reasons for use / non-use that may not be readily available in EHR data. Interviews will also assess the tool’s acceptability and feasibility for use among patients with multimorbidity. In Aim 3, she will conduct an EHR- and claims-based longitudinal retrospective cohort study to evaluate how use of the tool affects adherence and diabetes control in a subgroup of ~29,000 patients aged >50 with diabetes and multimorbidity. Throughout the award, Dr. Sloan will pursue training in geriatric and multimorbidity research, medical deci- sion-making, mixed methods, and program evaluation methods. Results from this award will directly inform the development of a multisite evaluation of price transparency tool implementation at institutions with different ge- ographies, patient populations, and practice patterns. The rigorous training and mentorship provided by this award, as well as Duke University’s superb research environment, will prepare Dr. Sloan well for a career dedi- cated to improving access to affordable care for middle-aged and older adults with multimorbidity.

斯隆博士是一名普通内科医生和卫生服务研究人员，其长期职业目标是评估政策和干预措施的有效性，这些政策和干预措施解决了多个多发病的老年人护理障碍。许多多种多发性患者努力为其药物付费。这些患者的药物较低依从性，导致疾病进展，功能局限性，住院和死亡的风险更高。患者无法在其医疗决定中考虑药物费用，因为他们很少知道这些成本将是在去药房之前。如果临床医生可以访问有关患者医学的信息在处方点上，与Tion相关的自付费用，他们可以帮助患者申请财务状况端口或处方较低成本的替代方案。新的自付毒品价格透明度工具可以满足这一需求。医疗保险和医疗补助服务中心最近要求Medicare D部分计划使临床 - 面对自付毒品价格透明度工具，可通过电子健康可供诊所和医院记录（EHR）。没有人描述了这些工具的摄取和可接受性，或者它们对临床外的影响它是在中年和老年患者中的多种病毒。该K23奖的目标是评估一个大型学术卫生系统的初级保健提供者使用广泛可用的价格透明度工具以及处方点的价格透明度如何影响多种多发病的中年和老年患者的临床结局。卫生系统的价格透明度 2019年通过的工具与所有医疗保险计划兼容，约有95％的私人保险计划。在 AIM 1和2，斯隆博士将使用Ex-extrange描述价格透明度工具的吸收和可接受性种植式顺序混合方法设计。在AIM 1中，她将进行基于EHR的回顾性队列研究〜700名临床医生和约14万名> 50岁的患者，以确定临床和患者与使用相关的因素。在AIM 2中，她将进行约24次半结构化访谈，以探讨使用的原因 /不容易在EHR数据中获得的不使用。访谈还将评估该工具的可接受性和在多种病患患者中使用的可行性。在AIM 3中，她将进行基于EHR和索赔的纵向回顾性队列研究，以评估该工具的使用如何影响和糖尿病控制一个约29,000名患有糖尿病和多种疾病的患者的亚组。在整个奖项中，斯隆博士将接受老年医学和多医生研究的培训，医学研究制造，混合方法和程序评估方法。该奖项的结果将直接告知开发具有不同ge-机构的价格透明度工具实施的多站点评估杂乱无章，患者人群和练习模式。提供的严格培训和精神训练奖项以及杜克大学的出色研究环境，将为斯隆博士做好准备，为职业生涯做好准备为了改善具有多种多发性的中年和老年人获得负担得起的护理的机会。