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.

Sloan 博士是一名普通内科医生和卫生服务研究员，其长期职业目标是评估解决照顾患有多种疾病的老年人的障碍的政策和干预措施的有效性。许多患有多种疾病的患者难以支付药物费用。这些患者的药物费用较低。坚持，导致疾病进展、功能限制、住院和死亡的风险更高。患者在做出医疗决定时无法考虑药物费用，因为他们很少知道这些费用是什么如果登山者能够获取有关患者医疗的信息，那么费用将在到达药房之前进行。在开处方时与相关的自付费用，他们可以帮助患者申请经济支持港口，或开出成本较低的替代品，可以满足这一需求。医疗保险和医疗补助服务中心最近强制要求医疗保险 D 部分计划使临床医生- 面临通过电子医疗向诊所和医院提供自付费用的药品价格透明度工具没有人描述这些工具的使用和可接受性，或者它们对临床结果的影响。出现在患有多种疾病的中老年患者中。该 K23 奖项的目标是评估一个大型学术卫生系统的初级保健提供者如何使用广泛使用的价格透明度工具以及处方时的价格透明度如何影响患有多种疾病的中老年患者的临床结果该卫生系统的价格透明度。该工具于 2019 年采用，与该州所有 Medicare 计划和约 95% 的私人保险计划兼容。目标 1 和 2，斯隆博士将使用前专家描述价格透明度工具的采用和可接受性在目标 1 中，她将进行一项基于 EHR 的回顾性队列研究。约 700 名顾客和约 140,000 名年龄 > 50 岁且患有多种疾病的患者一起确定临床医生和患者在目标 2 中，她将进行约 24 次半结构化访谈来探索使用原因。 / EHR 数据中可能不易获得的不使用情况还将评估该工具的可接受性和有效性。在目标 3 中，她将进行基于 EHR 和索赔的研究。纵向回顾性队列研究，评估该工具的使用如何影响患者的依从性和糖尿病控制一个由约 29,000 名年龄 > 50 岁患有糖尿病和多种疾病的患者组成的亚组。在整个获奖过程中，斯隆博士将接受老年病学和多种疾病研究、医疗决策方面的培训。该奖项的结果将直接告知。对不同地域机构的价格透明度工具实施情况进行多站点评估由此提供的严格培训和指导。奖项以及杜克大学卓越的研究环境将为斯隆博士的职业生涯做好充分准备致力于改善患有多种疾病的中老年人获得负担得起的护理的机会。