The applicant aspires to test an intervention to improve the rational and cost-effective prescribing of cardiovascular medication, with the goal of reducing medication costs and improving patient medication adherence. The intervention proposed is the delivery of free generic drug samples for antihypertensive and lipid-lowering medications to physicians to be dispersed to patients. Patients frequently receive unnecessarily expensive cardiovascular medications when appropriate generics are available, patients are adherent to chronic cardiovascular therapy only about 60% of the time, and costs represent a key barrier to adherence for many patients. Previous research by the applicant indicates that patients are most adherent to chronic therapy when prescribed generic medications requiring less out-of-pocket costs. These findings underscore the need for interventions to steer patients towards generic medications when clinically appropriate. The objectives of this career development award are twofold: 1) to develop the skills needed to create and evaluate interventions to improve cost-effective, rational prescribing of cardiovascular medications, and 2) to perform a multi-faceted evaluation of an intervention to provide physicians with free samples of generic medications to treat hypertension and hypercholesterolemia. The applicant will study an existing intervention using secondary data and will conduct a randomized controlled trial to evaluate how the delivery of free generic samples influences prescribing behavior, adherence to therapy and guideline adherence. In order to inform the development of the intervention, the applicant will conduct a qualitative evaluation of patients'and physicians'perceptions about generic medication use and free medication samples. The Division of Pharmacoepidemiology at the Brigham and Women's Hospital is currently implementing a statewide academic detailing program to physicians in Pennsylvania which will provide an ideal setting for this intervention. The applicant will enroll in coursework at the Harvard School of Public Health to strengthen skills in interventional trial design and evaluation, methodology in epidemiology and policy evaluation. This award will assist this applicant to become an independent researcher who strives to improve rational prescribing and medication use for cardiovascular disease, reducing unnecessary costs while improving medication adherence and health outcomes.
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