University of Iowa Older Adults CERT

描述（由申请人提供）：14%至23%的老年人服用了他们不应该开的药物。高达40%的患者不按医嘱服药。某些药物如受体阻滞剂或ACE抑制剂的使用不足也值得关注。尽管存在临床实践指南，并且针对特定疾病偏离最佳实践的情况已被充分记录，但尚不清楚这些指南是否适用于患有多种合并症的老年人。在有限的临床情况下，临床试验证据表明老年人的治疗益处很强，老年人遵守指南的障碍更普遍，包括药物与药物相互作用、药物-疾病禁忌症、决策能力的改变以及多种药物引起的复合不良事件风险。爱荷华大学老年人CERTs （UIOAC）提供CERTs项目研究专业知识，用于(1)制定与政策相关的治疗效果和成本效益评估，这些评估是由功能状态、合并症和年龄等重要特征定义的老年人亚群；(2)识别和设计干预措施，以解决社区护理环境中老年人最佳治疗方法的障碍。我们的合作精神体现在我们与社区医生和药剂师研究网络的项目，以及与州和联邦资助机构以及包括健康计划和全国连锁药房组织在内的最终用户的合作中。

DESCRIPTION (Provided by the Applicant): Between 14 and 23% of the elderly receive a medication they should not have been prescribed. Up to 40% of patients do not take their medications as prescribed. Under-use of certain medications like beta blockers or ACE inhibitors is also of concern. Whereas clinical practice guidelines exist and departures from optimal practice are well-documented for specific diseases, it is not known whether such guidelines generalize to the elderly with multiple co-morbidities. In the limited clinical situations where clinical trial evidence of therapeutic benefit among the elderly is strong, barriers to guideline adherence are more prevalent in the elderly including drug-to-drug interactions, drug-disease contraindications, alterations in decision-making capacities, and compounded adverse event risk due to multiple medications. The University of Iowa Older Adults CERTs (UIOAC) offers the CERTs program research expertise for (1) making policy-relevant estimates of treatment effects and cost-effectiveness among subsets of the elderly defined by important characteristics such as function status, co-morbidity, and age and (2) identifying and designing interventions to address barriers to optimal therapeutics in the elderly in community care settings. Our collaborative spirit is indicated by our projects with community-based physician and pharmacist research networks and collaborations with state and federal funding agencies as well as end-users including health plans and a national chain pharmacy organization. The specific aims of the UIOAC are to: 1. Improve safety and effectiveness of medication use among older adults by a. A quasi-experimental intervention study of translating a collaborative model of hypertension management into community care of elderly patients. b. Three database studies and one prospective study of age disparities in chemotherapy treatments and function status, survival, and cost-effectiveness outcomes. c. A longitudinal survey of the effect of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) on patient medication safety and access. d. Three studies of age-related changes in patient decision making and their effect on health outcome. 2. Expand existing collaborations to new partnerships with private and public entities by a. A developmental project to formulate a structured procedure for identifying and resolving geriatric medication problems in the community with the goal of implementing the procedure in diverse public and private practice settings. 3. Educate providers, patients, and policy makers about therapeutic decision-making in the elderly.