A major public health problem in the United States is poor adherence with medications. An estimated 50% of persons prescribed pharmacological therapy for chronic conditions have difficulty adhering to their regimen after six months. This leads to worse clinical outcomes and increased health care utilization and cost. The consequences of poor adherence have not been well explored in arthritis and musculoskeletal conditions. Gout is an ideal condition in which to examine lack of adherence as it affects up to 5 million Americans, and its incidence is rising. Chronic gout is effectively treated with lifelong use of urate-lowering drugs (ULDs), and these agents are relatively inexpensive and have a low incidence of side effects. However, preliminary results suggest that only 40% of patients are adherent with ULDs. The coursework and series of projects outlined in the proposal will allow Dr. Harrold to gain the training and experience necessary to become an independent investigator conducting research that improves the care provided to patients with rheumatic diseases. The overall objective of the proposed study is to make a substantial scientific contribution to the understanding of adherence'with ULDs, with the development of an intervention to promote adherence.
The specific aims of this research are: 1) investigate rates of nonadherence with ULDs in gout patients and identify risk factors for nonadherence;2) identify patient, provider, and system factors that contribute to nonadherence;3) assess the impact of nonadherence with ULDs on clinical and cost outcomes;and 4) develop and pilot test an educational and telephone counseling intervention to promote adherence with ULDs. Existing administrative data will be analyzed to assess adherence among gout patients who are new users of ULDs, and characterize the individuals who are nonadherent in terms of patient, provider, and health system characteristics. In-depth patient and provider interviews will be conducted to explore reasons for nonadherence. The impact of nonadherence in terms of clinical outcomes and gout-associated health care utilization will be examined prospectively using questionnaires and administrative data comparing adherent patients to nonadherent patients. Lastly, an educational and elephone counseling intervention designed to promote adherence with ULDs will be developed and pilot ested. This work will provide critical experience and pilot data for a subsequent R01 application.
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