The adoption of anticoagulation patient self-monitoring has been limited primarily to non-minority and higher socioeconomic individuals. Factors influencing the adoption of self-monitoring of anticoagulation have not been systematically examined. Understanding these factors is especially important in minority underserved patients who are at highest risk for accessing high-quality care and of anticoagulation related complications. The long term goal of the candidate is to develop a successful career as an independent comparative-effectiveness re- searcher with a focus in technology-based patient-centered interventions that support convenient, accessible, and cost-effective models of care in patients with chronic illness. The objective in this K23 application is to identify factors influencing adoption and feasibility of anticoagulation self-monitoring in minority patients and refine a patient-centered educational intervention. The central hypothesis is that patient self-monitoring coupled with a patient-centered educational intervention for minority patients will result in anticoagulation control of comparable quality to that seen in specialized anticoagulation clinic-based monitoring The rationale for the proposed research is that minority populations are at highest risk of complications and creating a model of effective self-care is the first critical step in reducing the risk of complications resulting from poor anticoagulation control in these populations. Guided by preliminary data, the research objective of this proposal will be accomplished by pursuing three specific aims: 1) Identify patient and provider factors that influence adoption of anti- coagulation self-monitoring in a minority population. 2) Adapt and refine an education intervention that both addresses identified barriers and emphasizes identified positive influences to anticoagulation self-monitoring. 3) Demonstrate the feasibility and effectiveness of anticoagulation self-monitoring coupled with the educational intervention in a minority population. The approach is innovative, because it is a departure from the standard self-testing skill-based interventions, and it targets a disadvantaged, high-risk population in need of effective and convenient options to manage a potentially life threatening condition. The proposed research is significant, because it is the first step towards a reduction of health disparities for access to and adoption of effective models of self-care in high risk patients. To achieve the outlined research goals, Dr. Nutescu has developed a career development plan that focuses on a combination of mentoring and didactics to enhance her skills in qualitative methods, health behavior research, clinical trial design, and methodological issues addressing cross- cultural and health disparities research. Dr. Nutescu's research and career development plans will take place predominantly at the University of Illinois at Chicago. Her experienced mentoring team includes highly qualified, well funded independent investigators who are dedicated and enthusiastic about Dr. Nutescu's career potential and research proposal.

Public Health Relevance

The proposed research is relevant to public health because patients on anti-coagulant drugs require monitoring to avoid serious complications and death, but minority and disadvantaged populations are at highest risk because of the difficulty in obtaining monitoring in the clinic. Effective self-monitoring would improve outcomes and lower healthcare costs, and the objective of this proposed project is to provide evidence that anticoagulation self-monitoring along with patient-centered education is feasible in this population. Thus the proposed research is relevant to the part of NIH's mission that pertains to fostering innovative research strategies and their applications as a basis to advance significantly the Nation's capacity to improve health.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Mentored Patient-Oriented Research Career Development Award (K23)
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Special Emphasis Panel (ZHL1)
Program Officer
Sarkar, Rita
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University of Illinois at Chicago
Other Health Professions
Schools of Pharmacy
United States
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Arwood, M J; Deng, J; Drozda, K et al. (2017) Anticoagulation endpoints with clinical implementation of warfarin pharmacogenetic dosing in a real-world setting: A proposal for a new pharmacogenetic dosing approach. Clin Pharmacol Ther 101:675-683
Manzoor, Beenish S; Lee, Todd A; Sharp, Lisa K et al. (2017) Real-World Adherence and Persistence with Direct Oral Anticoagulants in Adults with Atrial Fibrillation. Pharmacotherapy 37:1221-1230
Cavallari, Larisa H; Lee, Craig R; Duarte, Julio D et al. (2016) Implementation of inpatient models of pharmacogenetics programs. Am J Health Syst Pharm 73:1944-1954
Arwood, M J; Chumnumwat, S; Cavallari, L H et al. (2016) Implementing Pharmacogenomics at Your Institution: Establishment and Overcoming Implementation Challenges. Clin Transl Sci 9:233-245
Drozda, Katarzyna; Wong, Shan; Patel, Shitalben R et al. (2015) Poor warfarin dose prediction with pharmacogenetic algorithms that exclude genotypes important for African Americans. Pharmacogenet Genomics 25:73-81
Barta, Ashley L; Nutescu, Edith A; Thompson, Paul A et al. (2015) Relationship between time spent at extreme International Normalized Ratios and time in therapeutic range with bleeding and thrombosis in warfarin-treated patients. Am J Health Syst Pharm 72:1188-94
Lee, Yee Ming; Eggen, Jessica; Soni, Vinay et al. (2014) Warfarin dose requirements in a patient with the CYP2C9*14 allele. Pharmacogenomics 15:909-14
Cavallari, L H; Nutescu, E A (2014) Warfarin pharmacogenetics: to genotype or not to genotype, that is the question. Clin Pharmacol Ther 96:22-4
McConeghy, Kevin W; Bress, Adam; Qato, Dima M et al. (2014) Evaluation of dabigatran bleeding adverse reaction reports in the FDA adverse event reporting system during the first year of approval. Pharmacotherapy 34:561-9
Cavallari, Larisa H; Nutescu, Edith A; Duarte, Julio D (2013) Personalized medicine in cardiology: the time for genotype-guided therapy is now. Future Cardiol 9:459-64

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