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Riekert Lab

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Success with Therapies Research Consortium

Past & Current Projects

  • Principal Investigator: Dr. Kristin Riekert
    Project Number: R01DK092919
    Project Dates: 09/01/2012 – 05/31/2016
    Funding Source: National Institute of Diabetes and Digestive and Kidney Diseases

    Hypertension is one of the most important independent risk factors for chronic kidney disease (CKD) progression. The results of the recently completed ESCAPE trial highlight the importance of blood pressure control as a means to slow CKD progression, making antihypertensive nonadherence a prime target for behavioral intervention. Surprisingly, there is no research on adherence to antihypertensive medication among children either with or without CKD. Physician-adolescent communication is key for facilitating lifelong self-management skills and changes as the adolescent matures and assumes more responsibility for his/her care. However, there is a striking gap in our knowledge of physician-adolescent communication in general and specifically how it impacts regimen adherence and health outcomes. Evaluating how known risk and resilience factors and physician-adolescent communication interact through a comprehensive, longitudinal predictive model of adolescent nonadherence in CKD is an essential prelude to the development of effective, targeted adherence interventions for high-risk patients. The purpose of this study is to test 1) the impact of antihypertensive medication adherence in adolescents on blood pressure control and subsequent progression of CKD; and 2) the influence of physician-adolescent communication on medication adherence over time. This is a prospective study of 150 adolescents age 11-19 years old with CKD (Stages 1-5) who are prescribed an antihypertensive medication. Objective measurement approaches will be used to assess antihypertensive medication adherence (electronic monitoring and pharmacy refills), health outcomes (e.g., ambulatory blood pressure monitoring and biomarkers of CKD progression), and physician-adolescent communication (RIAS coding of nephrology clinic visits). Additionally, the moderating effect of known nonadherence risk and resilience factors on the association between physician-adolescent communication and adherence will be assessed. All variables will be measured at baseline, 12- and 24- months; additionally, adherence and health outcomes will be measured at 6-, 18- and 30-months. Longitudinal analyses will be used to model the change in outcomes with time-varying covariates. This will allow us to evaluate how changes in physician-adolescent communication impact adherence and then subsequent blood pressure control and CKD progression. Further, the lessons learned in this study of adolescents with CKD will add to our understanding of the impact of physician-adolescent communication across chronic illnesses.

  • Principal Investigator: Drs. Christopher Goss and Noah Lechtzin
    Co-Investigator: Dr. Kristin Riekert
    Project Number: R01HL103965
    Project Dates: 9/27/2010-6/30/2015
    Funding Source: National Heart, Lung and Blood Institute

    Individuals with cystic fibrosis (CF) are plagued by daily respiratory symptoms such as cough and dyspnea. In spite of dramatic improvements in care, their lives are greatly shortened due to progressive respiratory failure. The course of CF is marked by recurrent pulmonary exacerbations characterized by worsened symptoms and declines in pulmonary function. CF acute pulmonary exacerbations result in more rapid decline in lung function and increased. Preliminary data from our groups suggest that delays in seeking care are associated with lack of recovery of lung function after an exacerbation. The primary goal of this proposal is to perform a clinical trial to determine the efficacy of early intervention in the treatment of adolescent and adult CF acute pulmonary exacerbation. The study will assess the integration of two novel approaches to the treatment of CF pulmonary exacerbation: 1) the use of home spirometers to identify and trigger treatment of an exacerbation; and 2) the use of home based assessment of patient symptoms to identify and trigger the treatment of a pulmonary exacerbation, both integrated into one protocolized care plan. This novel approach will be compared to usual care with the primary outcome measure being lung function as measured with forced expiratory volume in the first second (FEV1). We hypothesize that if pulmonary exacerbations are treated earlier with a multi-faceted intervention, the progression of lung disease will be slowed. This approach will utilize state of the art, telehealth equipment to improve the assessment and delivery of care to adolescents and adults with CF. The primary goal of this proposal is to perform a clinical trial to determine the efficacy of early intervention in the treatment of adolescent and adult CF acute pulmonary exacerbation using remote monitoring with home spirometry and respiratory symptom assessment and protocolized management of CF exacerbation. This approach will utilize state of the art, telehealth equipment to improve the assessment and delivery of care to adolescents and adults with CF.

  • Principal Investigator: Dr. Kristin Riekert
    Project Details: Research Information and Participating Sites
    Project Dates: 10/01/2009 – 12/31/2014
    Funding Source: Cystic Fibrosis FoundationGenentech and Novartis Pharmaceuticals

    Clinicians often do not have sufficient information and communication tools to accurately assess their patients’ adherence. Patient nonadherence is a significant contributor to poor health outcomes and increased healthcare utilization. A central goal of this study is to test a potentially effective adherence intervention for adolescents and young adults seen in outpatient clinics. The intervention strategy is to implement a comprehensive adherence program (CAP) that includes assessment of knowledge of disease, skills in performing treatment-related behaviors, and problem-solving key barriers to adherence. The study design is a 2-arm randomized controlled trial with the CF care center as the unit of randomization. Centers will be stratified on relevant center characteristics (e.g., clinic size, case mix, such as transplant center and lung function) and whether they are a member of the CF Therapeutics Development Network. Care centers will be randomly assigned to receive the CAP intervention or no intervention in year 1 of the study. Centers that receive no intervention in year 1 of the study will receive the CAP intervention in the second year of the study. Providing the intervention to all care centers in Year 2 is a valuable part of the evaluation because (1) it allows for replication of the initial intervention results without recruiting a new sample, (2) permits evaluation of the sustainability of outcomes, (3) reduces care center demoralization about being assigned to no intervention in year 1 of the study, thereby reducing data attrition, and (4) increases the likelihood of seeing changes in health outcomes.

  • Principal Investigator: Dr. Kristin Riekert
    Project Number: R01HL087997
    Project Dates: 02/01/2008 – 01/31/2013
    ​Funding Source: National Heart, Lung and Blood Institute

    Treatment advances during the past two decades in the treatment of CF have resulted in improved survival and center around preventing the loss of lung function. In 2005 the median predicted survival for people on the Cystic Fibrosis Foundation Patient Registry was 36.8 years and over 40% of all living people with CF are adults. The therapeutic treatment regimen, however, has evolved into a complex home treatment program that requires a substantial amount of patient commitment to perform and adherence to many components of CF treatment is often poor. While the regimen is efficacious in improving lung health and mortality, there is limited data on the level of adherence needed to maximize health outcomes. Similarly, there are few published adherence-promoting studies in CF and these have been limited to pediatric populations. Older adolescent and adult-focused interventions are therefore needed that target the unique challenges managing CF as one gets older and more independent. Motivational Interviewing (MI) is a promising interventional approach that uses a client-centered, non- directive approach for enhancing motivation to change health behaviors and has promising data as an effective adherence promoting intervention for adolescents and adults with other chronic illnesses. MI does not assume that health will be the most important factor motivating the client, but rather acknowledges and incorporates other motivators identified by the client. We propose to evaluate the efficacy of an Motivational Interviewing-focused intervention (MI) in improving adherence and reducing CF-related morbidity among older adolescents and adults compare to a standard CF education intervention (CFE; attention control group). Specifically, we hypothesize that MI will result in improved disease self-management and reduced CF morbidity compared to the CFE control group in a sample of 153 individuals with CF age 16+ years who are clinically stable at baseline. Our primary hypothesis is that participants receiving MI will have a higher composite medication adherence score at 12-months post-randomization (measured by pharmacy refill records) compared to the CFE group. Secondary outcomes include self-reported adherence, lung function (CF-specific percentiles of FEV1), pulmonary exacerbations, body mass index, and quality of life. This study will allow us to evaluate the longitudinal association between adherence and health outcomes. We will also evaluate the mediating effects of self-efficacy, motivation and CF knowledge on the intervention outcomes as well as moderator effects, such as age, autonomy, depression, social support, and life events.

 

Collaborations and Partnerships

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