The Program for the Study of Health Care Relationships funded 11 researchers in CT to study various aspects of health care relationships and adherence. The individuals listed below each received grants for one year (2001-02). They were awarded funds on the basis of a competitive review process and the scientific merit of their proposals. The wide range of disciplines they represent and their research interests demonstrated the diversity and complexity inherent in studying health care relationships.

• Development of an Instrument to Measure Patients' Trust of Health Care Providers
• Exploration of the Effect of Nausea, Self-Efficacy, and Health Care Relationships on Medication Adherence in HIV/AIDS Patients
• Advance Care Planning: A Team Approach
• Assisting Older Adults To Communicate Their Pain After Surgery
• The Effect of a Specialized RN Intervention Designed to Maximize Patient-Provider Relationships on Adherence to Anti-Depressant Medication
• Pilot Study of Rapid Electronic Adherence Reporting with Provider Feedback on Adherence to Antiretroviral Therapy (HCR 01-12)
• Development of a Measure of Family Management of Childhood Chronic Illness
• The Contribution of Health Care Professionals to Parent and Child Self-Management of Type 1 Diabetes
• Enhancing Treatment Access and Adherence among Women of Hispanic Origin: The Roles of Relationships and Cultural Responsiveness in Behavioral Health Care
• Elicitation of Patient with Adaptive Conjoint Analysis

Elicitation of Patient with Adaptive Conjoint Analysis

Liana Fraenkel MD, MPH, Principal Investigator

Background
The objectives of this study were to i) examine patient treatment preferences for knee osteoarthritis, ii) determine the influence of specific medication characteristics on patientsŐ choices, and iii) examine whether patient preferences are consistent with current practice.

Methods
100 consecutive patients with symptomatic knee osteoarthritis completed an interactive computer questionnaire administered during a face-to-face interview. We measured the relative impact of specific medication characteristics (including administration, risks, benefits, and cost) on patientsŐ choice, and the percent of patients preferring nonselective nonsteroidal antiinflammatory drugs (NSAIDs), cyclooxygenase -2 inhibitors, glucosamine and/or chondroitin sulfate, opioid derivatives and capsaicin across varying risks, benefits, and costs.

Results
Of the characteristics studied, variation in the risk of common adverse effects and gastrointestinal ulcer had the greatest impact on patientsŐ choice. Assuming patients are responsible for the full cost of their medications, over 40% prefer capsaicin. Cyclo-oxygenase -2 inhibitors become patientsŐ preferred choice only if they are described as being three times as effective as capsaicin and are covered by insurance. Nonselective NSAIDs are among the least preferred options across all simulations.

Conclusions
When evaluating multiple alternatives, many older patients with knee osteoarthritis are willing to forego treatment effectiveness for a lower risk of adverse effects. The patient treatment preferences derived in this study conflict with the current widespread use of nonselective NSAIDs in older arthritis patients.

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