Candidate Career Goals: Dr. Ernest R. Vina's long-term career goal is to promote equity for patients with rheumatic and musculoskeletal diseases through the development of interventions to eliminate racial disparities and improve outcomes for patients with these diseases. With his research and clinical experience in addressing the sources of racial disparities in the health and health care of patients with rheumatic diseases, Dr. Vina is well-suited to build a research career in this area. However, he will require additiona training and skills in order to address knowledge gaps by exploring patient characteristics and health beliefs that may contribute to disparities in the medical care of patients with osteoarthrits (OA). Dr. Vina's short-term career goals are 1) to develop the expertise required to study the reasons why race disparities in the use of different types of non-surgical OA treatment exist; and 2) to learn to develop an intervention and implement a clinical trial to reduce racial disparities n the use of various OA treatments. Research Background: OA is a highly prevalent and disabling disease. Racial disparities in the outcomes of OA patients have also been demonstrated, with African-Americans (AAs) carrying a greater burden than whites (WHs). In addition, AAs are also less likely to have history of use of various pharmacologic and non- pharmacologic therapies for OA. Sources of racial healthcare disparities in OA are only partially known.
Research Aims : There are two main aims for this K23. The first is to examine the determinants of, and barriers to, the utilization of various OA treatments that contribute to disparities in the care of AAs and WHs. The second is to pilot-test the impact of an intervention designed to improve the utilization of effective, non- surgical OA treatments. Methods: To achieve the goals of the first aim, surveys of patients with knee or hip OA will be conducted. The survey will determine patient demographic information, psychosocial characteristics, disease severity, treatment history and health-related knowledge, beliefs and attitudes. The primary outcomes of interest will include utilization of various treatments, including exercises, topical medications, non-steroidal anti- inflammatory drugs and opioid agents. Hierarchical statistical modeling will be conducted to determine which patient-level variables may mediate racial disparities in the utilization of the various OA treatments. For the second aim, an existing educational tool will be chosen and enhanced with the goal of improving patient understanding of OA treatments and increasing the use of available OA therapies. Thereafter, this instrument will be pilot-tested to a relatively smal group of patients with knee or hip OA. The impact of this educational tool in improving the utilization of various OA therapies will be preliminarily determined.

Public Health Relevance

Osteoarthritis (OA) is the most common form of arthritis and is a leading cause of pain and disability among the elderly. Racial differences in the outcomes of OA patients exist; African-Americans are more likely to experience pain from OA and are less likely to be using effective OA treatments than whites. The current project proposes to identify the contributors to racial differences in the use of various OA therapies and to develop an educational tool that will improve understanding and use of these treatments.

National Institute of Health (NIH)
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Mentored Patient-Oriented Research Career Development Award (K23)
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Arthritis and Musculoskeletal and Skin Diseases Special Grants Review Committee (AMS)
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Lester, Gayle E
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University of Arizona
Internal Medicine/Medicine
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United States
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Abbate, Lauren M; Jeffreys, Amy S; Coffman, Cynthia J et al. (2017) Demographic and Clinical Factors Associated with Non-Surgical Osteoarthritis Treatment Use Among Patients in Outpatient Clinics. Arthritis Care Res (Hoboken) :
Vina, Ernest R; Kallan, Michael J; Collier, Aliya et al. (2017) Race and Rehabilitation Destination After Elective Total Hip Arthroplasty: Analysis of a Large Regional Data Set. Geriatr Orthop Surg Rehabil 8:192-201