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Using Burden of Treatment as a Clinical Indicator of Barriers to Multimorbidity Management in Peru: A Mixed Methods Approach

Award Number: R21TW011740
ORGANIZATION: FOGARTY INTERNATIONAL CENTER
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 09/15/2020
PERIOD OF PERFORMANCE END DATE: 06/30/2025

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Using Burden of Treatment as a Clinical Indicator of Barriers to Multimorbidity Management in Peru: A Mixed Methods Approach - ABSTRACT Multimorbidity is increasing throughout the world. In many high-income countries (HICs), it is the norm rather than the exception, and low-and-middle-income countries (LMICs) are heading in this direction.1 Multiple studies have shown that patients with multimorbidity suffer from worse clinical outcomes.2 Part of this is due to the fact that they experience a higher burden of treatment (BOT), which is defined as how their healthcare workload - or all of the things they must do to comply with their medical treatment - affects their functionality and well-being. One of the many factors that increases healthcare workload and consequently BOT is the presence of healthcare system-related barriers. In LMICs, healthcare systems have evolved to treat acute conditions rather than manage chronic ones and consequently are replete with numerous barriers preventing successful multimorbidity management.1, 2 In order to improve outcomes in multimorbidity, it is crucial to create patient-centered interventions minimize these barriers. Sustainable implementation of these changes, however, requires the use of quality indicators, one of which is BOT. Although several patient-reported outcome measures have been identified to measure BOT in clinical settings, their use in LMICs has been limited. In this study, we will evaluate BOT in multimorbid patients in Peru using a mixed-methods approach. Both semi-structured interviews and a validated survey, the Treatment Burden Questionnaire (TBQ), will be applied to patients in different healthcare settings and geographic regions. Our overarching goal is to gain an in-depth understanding of what patient- reported barriers to multimorbidity management exist in Peru, and we aim to achieve the following specific objectives: 1) To use BOT to identify and compare patient-reported barriers to multimorbidity management in groups receiving care in private versus public healthcare sectors in Peru. 2) To use BOT to identify and compare patient-reported barriers to multimorbidity management in patients receiving care in different geographic regions in Peru. 3) To use semi-structured interviews with patients to gain additional, in-depth information about barriers to multimorbidity management in Peru. We believe that the novel approaches used in this study have significant potential to advance the field of global multimorbidity. The use of the TBQ to compare BOT in patients receiving different types of healthcare and in different locations will advance its use as an indicator of healthcare quality. Moreover, the use of qualitative methods will allow us to understand what barriers exist in Peru and how well they are captured by the TBQ. This unique approach will will serve as a model for how the TBQ can be adapted for use in other unique healthcare contexts. Using a reliable tool to understand the relationship between BOT and healthcare systems - particularly those in LMICs - has the potential to provide a foundation for patient- centered interventions that target the most burdensome and costly aspects of multimorbidity care. 1


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2026 ( Subtotal = -$2,387 )
2026	2021	UNIVERSIDAD PERUANA CAYETANO HEREDIA	AVENIDA HONORIO DELGADO 430 URB URB INGENIERIA	LIMA				PER	International Research and Research Training	000	2	11/13/2025	NON-COMPETING CONTINUATION	-$2,387
														Subtotal = -$2,387

Issue Date FY: 2024 ( Subtotal = $0 )
2024	2021	UNIVERSIDAD PERUANA CAYETANO HEREDIA	AVENIDA HONORIO DELGADO 430 URB URB INGENIERIA	LIMA				PER	International Research and Research Training	001	2	6/18/2024	NON-COMPETING CONTINUATION	$0
2024	2021	UNIVERSIDAD PERUANA CAYETANO HEREDIA	AVENIDA HONORIO DELGADO 430 URB URB INGENIERIA	LIMA				PER	International Research and Research Training	000	2	12/12/2023	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2023 ( Subtotal = $0 )
2023	2021	UNIVERSIDAD PERUANA CAYETANO HEREDIA	AVENIDA HONORIO DELGADO 430 URB URB INGENIERIA	LIMA				PER	International Research and Research Training	000	2	7/18/2023	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2021 ( Subtotal = $145,903 )
2021	2021	UNIVERSIDAD PERUANA CAYETANO HEREDIA	AV. HONORIO DELGADO 430	LIMA	LIMA			PER	International Research and Research Training	000	2	7/7/2021	NON-COMPETING CONTINUATION	$145,903
														Subtotal = $145,903

Issue Date FY: 2020 ( Subtotal = $150,825 )
2020	2020	UNIVERSIDAD PERUANA CAYETANO HEREDIA	AV. HONORIO DELGADO 430	LIMA	LIMA	15102		PER	International Research and Research Training	000	1	8/14/2020	NEW	$150,825
														Subtotal = $150,825

Grand Total All Awards = $294,341

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Using Burden of Treatment as a Clinical Indicator of Barriers to Multimorbidity Management in Peru: A Mixed Methods Approach

Award Number: R21TW011740

ORGANIZATION: FOGARTY INTERNATIONAL CENTER

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 09/15/2020

PERIOD OF PERFORMANCE END DATE: 06/30/2025

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