Significant high order drug interactions in the emergency department setting among older patient population
急诊科老年患者群体中存在显着的高阶药物相互作用
基本信息
- 批准号:10367528
- 负责人:
- 金额:$ 37.93万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2022
- 资助国家:美国
- 起止时间:2022-02-01 至 2026-11-30
- 项目状态:未结题
- 来源:
- 关键词:Accident and Emergency departmentAddressAdultAdverse drug eventAdverse eventAnticoagulantsAntidiabetic DrugsBiologicalCaringCause of DeathCharacteristicsChronicClinicalClonidineDataDatabasesDevelopmentDiagnosisDrug CombinationsDrug InteractionsDrug KineticsDrug usageElderlyElectronic Health RecordEmergency department visitExposure toFluconazoleFutureGastrointestinal HemorrhageGoalsHealthHealth PersonnelHealthcare SystemsHigh PrevalenceHospitalizationHospitalsHumanHypoglycemiaImpaired cognitionIndianaIndividualKnowledgeLiteratureMeasuresMedicareMethodsModelingMyopathyOhioOmeprazoleOpioidPatientsPharmaceutical PreparationsPharmacoepidemiologyPharmacologyPharmacy facilityPolypharmacyPopulationPreventionProceduresProviderPublic HealthPublishingRecommendationResearchResearch DesignReview CommitteeRiskRisk FactorsSafetyServicesTechniquesTherapeuticTimeTrainingTreatment outcomeVisitadjudicatebasecomorbiditycomparativecomparative safetydata miningdesigndrug misusefrailtyhealth care service utilizationhealth datahigh riskhuman old age (65+)insurance claimsinterestolder patientpatient populationpatient safetypharmacokinetic modelphysiologically based pharmacokineticspopulation basedpreventresponsesafety assessmenttoolyoung adult
项目摘要
Older adults (≥65 years old) constitute about 17% of the US population but account for ~57% of the population
who use ≥3 drugs (polypharmacy). Currently, ~30million US adults use ≥3 drugs which increase their exposure
to high-order drug-drug interactions (HDDIs), i.e. drug-drug interactions involving ≥3 drugs. HDDI is a major risk
factor of serious adverse drug events (ADEs) that result in emergency department (ED) visits or hospitalization.
Older adults, compared to younger adults, are 7-times more likely to be hospitalized and 2 to 3-times more likely
to visit the ED for ADEs. However, knowledge on how to identify HDDI-ADE associations, data on the
comparative safety of different 3-drug combinations and clinical and pharmacokinetic mechanisms for HDDI-
ADE associations are all critically limited. The current project is designed to address these major gaps by
specifically: (1) applying our state-of-art data mining techniques to discover HDDIs that are associated with
higher risk of ADEs as well as those associated with lower ADE risk; (2) performing a comparative safety
assessment of 3-drug combinations involving anticoagulants, antidiabetic agents and opioids; and (3) validating
and evaluating the clinical validity and pharmacologic mechanisms of HDDI-ADE associations.
These aims will be implemented by focusing on older patients who had an ED visit based on real-world
data from health insurance claims (MarketScan and Medicare) and Electronic Health Records (EHR) data. We
will focus on gastrointestinal (GI) bleeding, hypoglycemia and opioid-induced ADEs as the primary ADEs of
interest for all three aims. These three ADEs account for 60% of all ADE-induced ED visits and are a target
priority for prevention and surveillance by the US Health and Human Services. Our preliminary data from the
MarketScan claims data (2012-2018) alone has confirmed that older adults are at higher risk of ADEs and that
the risk of these ADEs increase with the counts of concomitant drugs used by patients. We will apply our mixture
drug-count response (MDCR) and graphical models to identify the specific 3- or 4-drug combinations that have
the highest risk and those with the lowest risk of ADEs in ED settings among older adults (Aim 1). For Aim 2, we
will apply pharmacoepidemiologic study designs and casual inference approaches to assess the comparative
safety of specific high and low-risk 3-drug combinations. We will control for the potential confounding effects of
several patient-level (demographic, clinical, chronic comorbidities, drug characteristics, healthcare utilization, etc)
and provider/healthcare system-level factors to assess the causal associations between high-risk versus low-
risk 3-drug combinations. Finally, we will use a clinician expert team to evaluate the HDDI-ADE pairs and
associations identified from Aims 1 and 2 for clinical validity and utility.
The identification of high- and low-risk 3-drug combinations is vital knowledge that could guide the
development of new polypharmacy prescribing recommendations to help address the significant public health
challenge created by ADEs.
老年人(≥65岁)约占美国人口的17%,但占总人口的57%
项目成果
期刊论文数量(0)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
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Macarius M. Donneyong其他文献
Macarius M. Donneyong的其他文献
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{{ truncateString('Macarius M. Donneyong', 18)}}的其他基金
Significant high order drug interactions in the emergency department setting among older patient population
急诊科老年患者群体中存在显着的高阶药物相互作用
- 批准号:
10559571 - 财政年份:2022
- 资助金额:
$ 37.93万 - 项目类别:
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