Preventing the Calcium Channel Blocker – Lower Extremity Edema – Loop Diuretic Prescribing Cascade in Older Adults

预防钙通道阻滞剂 – 下肢水肿 – 老年人袢利尿剂处方级联

• 批准号: 10399417
• 负责人: Scott Martin Vouri
• 金额: $ 16万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-01 至 2022-10-20
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10399417
• 关键词: Address; Adoption; Adult; Adverse effects; Adverse event; Aging; Algorithms; Antihypertensive Agents; Area; Award; Big Data; Biometry; Calcium Channel Blockers; Canada; Cardiovascular system; Caring; Cessation of life; Clinic; Clinical; Clinical Data; Clinical Decision Support Systems; Clinical Management; Combination Medication; Complex; Dangerousness; Data; Dehydration; Detection; Development; Disease; Diuretics; Dose; Drug Combinations; Drug Evaluation; Drug Interactions; Edema; Effectiveness; Elderly; Electronic Health Record; Ensure; Environment; Evaluation; Exposure to; Faculty; Florida; Foundations; Funding; Future; Geriatrics; Goals; Health; Health Care Costs; Healthcare Systems; Hypertension; Hypotension; Incidence; Incontinence; Individual; Intervention Studies; K-Series Research Career Programs; Lead; Lower Extremity; Medical; Medicare; Medicare claim; Mentors; Mentorship; Methods; Observational Study; Outpatients; Output; Overactive Bladder; Patients; Personal Satisfaction; Pharmaceutical Preparations; Pharmaceutical Services; Pharmacoepidemiology; Pharmacotherapy; Pharmacy facility; Physicians; Polypharmacy; Population; Predisposition; Process; Provider; Regimen; Research; Research Methodology; Resources; Risk; Role; Testing; Time; Training; Universities; Urinary Incontinence; Validation; Visit; Work; adverse event risk; age related; base; clinical decision support; clinical development; clinical implementation; clinical practice; combat; comorbidity; cost; data infrastructure; design; disability; drug testing; economic evaluation; effective intervention; experience; fall injury; falls; feasibility testing; future implementation; health care service utilization; high risk; hypertension control; implementation evaluation; implementation research; implementation science; improved; individual patient; longitudinal analysis; medication safety; multidisciplinary; multiple chronic conditions; pharmacovigilance; prevent; programs; prospective; risk stratification; support tools; therapy outcome

PROJECT SUMMARY. Prescribing cascades (PCs), in which drug-induced adverse events (AEs) result in additional treatment rather than deprescribing or dose reduction of the offending agent, are a central problem in geriatric polypharmacy. Unlike other drug combinations that should be avoided, such as drug-drug interactions, there is currently no process that alerts providers of PCs. To prevent or deprescribe PCs, providers must evaluate complex medication regimens and multiple chronic conditions that may contribute to drug-induced AEs. Appropriate design and implementation of clinical decision support (CDS) offers a promising approach to enhance timely detection of PCs. In this work, I will use a research framework that evaluates PCs and develops CDS tools for detection in clinical practice, using the example of a presumably common and problematic PC: calcium channel blocker-associated lower extremity edema leading to the prescribing of a loop diuretic (CCBLEELoop). My specific aims include (Aim 1) estimating the incidence and evaluating which populations are at highest risk of CCBLEELoop PC, (Aim 2) quantifying excess AEs, healthcare utilization, and costs associated with the CCBLEELoop PC, and (Aim 3) developing and validating a CCBLEELoop PC algorithm for use in CDS to prospectively identify individuals with the PC. This NIA K08 proposal will lay the foundation, both in training and research output, for building an independent research program that combats polypharmacy in older adults, with particular focus on minimizing unnecessary medication use. My extensive experience in geriatric clinical pharmacy and my role as the Assistant Director of Pharmacy Services with University of Florida (UF) Health Physicians, the faculty practice of UF Health, will ensure deep clinical context and relevance of this work. My initial exposure to observational research methods and experience with Medicare data during my doctoral training will be enhanced through this K award in three distinct areas relevant to the proposed work: (1) pharmacoepidemiologic methods including the use of advanced longitudinal analyses to make causal inferences on drug effects, (2) development and validation of CDS, and (3) implementation science. UF Health is the largest fully-integrated academic health center in the Southeast and its excellent big data infrastructure provides an ideal environment for achieving the proposed objectives and my long-term goals. Dr. Winterstein will guide my training in pharmacoepidemiology and lead a multidisciplinary mentorship team composed of experts in CDS development and implementation and economic evaluation of drug effects (Dr. Malone), aging (Dr. Manini), biostatistics (Dr. Brumback), clinical management of hypertension (Dr. Pepine), clinical geriatrics (Dr. Solberg), and alert development, evaluation, and implementation (Dr. Staley). The integrated mentored research experience and training will allow me to compete for R01 funding focused on CDS implementation and build an independent research program that combats polypharmacy in older adults.

项目摘要。处方级联（PC），其中药物诱导的不良事件（AES）导致 额外的治疗而不是划分或减少违规药的剂量是一个核心问题 在老年多药体中。与应避免的其他药物组合不同，例如毒品药物 交互，目前尚无提醒提供商PC的过程。为了防止或描述PC， 提供者必须评估复杂的药物治疗方案和多种慢性病，这可能有助于 药物引起的AE。临床决策支持（CD）的适当设计和实施 有前途的方法来增强PC的及时检测。在这项工作中，我将使用一个研究框架 评估PC并开发CDS工具在临床实践中进行检测，以大概是 常见和问题的PC：钙通道阻滞剂相关的下肢水肿导致 开处方利尿剂（CCBLeeLoop）。我的具体目的包括（目标1）估计事件 并评估哪些人群的最高风险是CCBLeeLoopPC，（AIM 2）量化 AES过多，医疗保健利用以及与CCBLeeroop PC相关的成本，并且（AIM 3） 开发和验证CCBLeeLoopPC算法用于CD，以便识别 个人使用PC。该NIA K08提案将在培训和研究成果中奠定基础 建立一项独立研究计划，该计划与老年人打击多重药物，特别是重点 最小化不必要的药物使用。我在老年临床药房和角色方面的丰富经验 作为佛罗里达大学（UF）卫生医生的药房服务助理主任，教师 UF健康的实践将确保这项工作的深层临床环境和相关性。我最初接触 在我的博士培训期间，观察性研究方法和Medicare数据的经验将是 通过该K奖在与拟议工作有关的三个不同领域中得到增强：（1） 药物ePidemiologic方法，包括使用高级纵向分析来使因果关系 推论药物影响，（2）CD的开发和验证以及（3）实施科学。 UF健康 是东南部最大的完全集成的学术健康中心及其出色的大数据基础设施 为实现拟议的目标和我的长期目标提供了理想的环境。温特斯坦博士 将指导我在药物epidemiology方面的培训，并领导由由 CDS开发和实施和药物效应的经济评估专家（Malone博士），衰老 （Manini博士），生物统计学（Brumback博士），高血压临床管理（Pepine博士），临床老年医学 （Solberg博士），并提醒开发，评估和实施（Staley博士）。综合问题很重要 研究经验和培训将使我能够争夺专注于CD实施的R01资金 并建立一项独立的研究计划，该计划与老年人打击多药。