Medication Use, Comorbidity and Outcomes in Older People

描述(由申请人提供)：患者特征，包括年龄、 合并症和预后会影响处方决策，并可能与 许多有价值的药物治疗使用不足，特别是在虚弱的老年人中 人。调查人员提出的流行病学研究将：a)确定 与发起决定有关的人口和健康相关因素 特定的药物方案，并保持对先前处方的遵守 治疗方法；以及b)澄清使用特定药物和 老年人的死亡率。研究将集中在特定的药物类别上，这些药物 尽管它们被证明有治疗价值，但通常没有得到充分利用 包括：降血脂药、β受体阻滞剂、血管紧张素转换酶 抑制剂、降血糖药和青光眼药物。其他方法论 目标是c)构建一个简单的、基于药物的共病指数，该指数预测 老年人死亡率和d)评估治疗的程度 通过纳入HCFA最低数据中的信息来澄清决定 准备好了。拟议的研究将利用来自两大种群的数据 65岁或以上人群：1)超过400,000名新泽西州居民 通过医疗补助或该州药房的处方药覆盖范围 1990-2000年为老年人或残疾人提供援助；2) 不列颠哥伦比亚省的所有居民，包括超过50万人在 1995-2000年，谁通过该省的 普惠性老年药品福利计划。这些应用程序的数据源 人口包括：来自这些福利计划的处方药索赔；数据 关于住院情况，包括出院诊断、门诊信息 访问和诊断，以及可从平行数据库获得的死亡率；以及 有关新泽西州患者特征的详细信息 疗养院的居民可从HCFA的最低数据集中获得。这项研究 人口死亡率高，并包含大量的亚群 治疗不足的特别风险，包括85岁及以上者，护理 家庭居民、妇女和黑人。对药物流行病学的澄清 根据目前的纵向数据，使用可以改善处方 从而降低高危人群的发病率和死亡率 人口。

DESCRIPTION (provided by applicant): Patient characteristics including age, comorbidity and prognosis affect prescribing decisions and may be associated with under-use of many valuable drug therapies, particularly in frail older persons. The investigators propose epidemiologic studies that will: a) identify demographic and health-related factors associated with the decision to initiate specific drug regimens and to maintain adherence to previously prescribed therapies; and b) clarify the relationships between use of specific drugs and mortality in the elderly. Studies will focus on specific drug classes that are commonly under-utilized in spite of their demonstrated therapeutic value including: lipid lowering agents, beta blockers, angiotensin converting enzyme inhibitors, hypoglycemic agents, and glaucoma drugs. Additional methodologic aims are c) to construct a simple, drug-based comorbidity index that predicts mortality in older persons and d) to evaluate the extent to which treatment decisions are clarified by inclusion of information from HCFA's Minimum Data Set. The proposed studies will utilize data from two large populations of persons aged 65 years or older: 1) over 400,000 residents of New Jersey who had prescription drug coverage through either Medicaid or that state's Pharmacy Assistance for the Aged or Disabled program during the years 1990-2000; and 2) all residents of British Columbia, including over 500,000 persons during the years 1995-2000, who received prescription benefits through that province's universal program of drug benefits for the elderly. Data sources for these populations include: prescription drug claims from these benefit programs; data on hospitalizations including discharge diagnoses, information on outpatient visits and diagnoses, and on mortality available from parallel databases; and detailed information on patient characteristics available for New Jersey residents in nursing homes available from HCFA's Minimum Data Set. The study populations have high death rates and contain large numbers of subgroups at particular risk for under-treatment including those aged 85 and above, nursing home residents, women and blacks. Clarification of the epidemiology of drug use, based on current longitudinal data, can lead to improved prescribing practices and thereby decrease morbidity and mortality in high-risk populations.