Reducing CNS-active Medications to Prevent Falls and Injuries in Older Adults

项目摘要 福尔斯是65岁及以上成年人致命和非致命伤害的主要原因。的药物 影响中枢神经系统（即，CNS活性药物）是福尔斯的一个关键可改变风险因素， 国家指导方针为有福尔斯风险的人提供了避免使用药物的明确指导。然而，在这方面， 医疗保健提供者和患者对与福尔斯有关的药物的认识较低，迄今为止， 药剂师在促进药物检查和减少以防止福尔斯跌倒方面的作用有限。新 因此，迫切需要采取办法，增加对建议的采纳。一个多方面的方法是 通常对于成功地逐渐减少和停止某些CNS活性药物至关重要，例如 苯二氮卓类和阿片类药物。STOP-EQUILLS的目标是实施和评估一个基于团队的 涉及药剂师、初级保健提供者和患者的干预，以减少CNS活性药物的暴露 增加老年人福尔斯跌倒和意外伤害风险的药物。我们干预的核心是 直接面向患者的教育和持续的提供者教育和支持。目标是：（1）适应和 采用和实施循证医学所需的试点方法 减少战略，用于综合保健系统; 2）实施和推广 采用观察性队列设计进行干预; 3）评估干预的障碍和促进因素 采用、实施和维护：临床领导影响、干预适应性，以及 执行费用。我们的干预队列将由正在服用一种或多种CNS的老年人组成， 在卫生系统开始实施干预措施后积极用药。我们会比较一下 使用相同资格标准的同一健康计划的近期历史比较队列的组 对于这些人，我们有人口统计学、医疗和用药史以及结果的可比数据。的 主要结局是24个月时接受药物治疗的福尔斯。次要结局将是 意外过量，由于机动车碰撞造成的伤害，以及 干预我们的应用是重要的，因为务实的方法，以减少不必要的中枢神经系统- 积极的药物使用，通过停止目前的使用和防止未来的使用，将大大提高 卫生系统实施基于人群的跌倒和伤害预防的能力。随着快速老化 人口和意外伤害的破坏性影响及其相关费用， 非常需要。这种模式还可以提高老年人更普遍的处方质量 成年人了

PROJECT SUMMARY Falls are the leading cause of fatal and non-fatal injuries among adults aged 65 and older. Medications that affect the central nervous system (i.e., CNS-active medications) are a key modifiable risk factor for falls, and national guidelines offer clear guidance on medications to avoid for those at risk of falls. However, healthcare provider and patient awareness of medications linked to falls is low, and to date the role of pharmacists in facilitating medication review and reduction to prevent falls has been limited. New approaches to increase uptake of recommendations are thus greatly needed. A multifaceted approach is often essential to successfully taper and discontinue certain CNS-active medications, such as benzodiazepines and opioids. The objective of STOP-FALLS is to implement and evaluate a team-based intervention involving pharmacists, primary care providers, and patients to reduce exposure to CNS-active medications that increase the risk of older adult falls and unintentional injuries. Central to our intervention is direct-to patient education and ongoing provider education and support. The aims are to: 1) ADAPT AND PILOT-TEST approaches necessary for adoption and implementation of evidence-based medication reduction strategies for use in an integrated health care system; 2) IMPLEMENT AND EVALUATE the intervention using an observational cohort design; and 3) ASSESS barriers and facilitators to intervention adoption, implementation and maintenance: clinical leadership influences, intervention adaptability, and implementation costs. Our intervention cohort will consist of older adults who are taking one or more CNS- active medications after the start of intervention implementation by the health system. We will compare this group with a recent historical comparison cohort from the same health plan using the same eligibility criteria for whom we have comparable data on demographics, medical and medication history, and outcomes. The primary outcome will be medically treated falls at 24 months. Secondary outcomes will be unintentional overdose, injuries due to motor vehicle crashes, and direct medical costs of the intervention. Our application is significant because pragmatic approaches to curtail unnecessary CNS- active medication use, by discontinuation of current use and preventing future use, will greatly enhance the capability of health systems to implement population-based fall and injury prevention. With a rapidly aging population and the devastating effects of unintentional injuries and their associated costs, such approaches are greatly needed. Such models could also improve the quality of prescribing more generally in older adults.