Medication Use, Comorbidity and Outcomes in Aging populations

描述（由申请人提供）：一组老年临床专家将药物管理问题评为改善弱势老年人护理的最重要目标。65岁或65岁以上的人的特定年龄药物消费率最高，但大量证据表明，他们通常没有接受各种情况的适当药物治疗。特别是，患有复杂慢性疾病的老年人似乎对不相关疾病接受预防性药物治疗的可能性较低。本应用程序旨在进行大规模，纵向，观察性研究的决定因素，开始和持续使用预防药物的老年人。特别关注常见症状，包括抑郁症、帕金森氏病和慢性阻塞性肺病，对使用预防性治疗的影响，包括青光眼药物、骨吸收剂和降脂药物。另一项评估将考虑生命最后一年的药物相对使用情况。其他方法学目标将量化处方者药物使用的聚类，并评估特定药物类别新使用者研究的替代参考组。研究将利用来自两大65岁或以上人群的行政索赔数据：1)在1994年至2005年期间，宾夕法尼亚州超过50万名老年人通过该州的老年人药房援助合同（PACE）计划获得处方药保险；2)不列颠哥伦比亚省的所有居民，包括1995年至2005年期间通过该省的药物保健计划获得处方福利的50多万人。这些人群的数据来源包括：所有配药处方的药品索赔；住院和门诊数据，包括诊断；患者及其开处方者的人口统计信息；以及项目资格和死亡率的信息。这些人群包括大量面临治疗不足特别危险的人，包括85岁及以上的人、妇女、黑人和患有多种疾病的人。数据分析将使用纵向和聚类数据的方法来解释同一人的重复处方，并描述处方者中患者的聚类特征。这些研究旨在推进评估老年人药物使用及其影响的方法学策略，并为干预措施奠定基础，以改善这一人群的处方。

DESCRIPTION (provided by applicant): A panel of geriatric clinical experts rated problems in pharmacologic management as the most important target for improvement of care in vulnerable older people. People aged 65 years or older have the highest age-specific drug consumption rates, yet abundant evidence indicates that they commonly do not receive appropriate drug treatment for a wide variety of conditions. In particular, older persons with complex chronic diseases appear to have a reduced likelihood of receiving preventive drug treatment for unrelated diseases. This application aims to conduct large-scale, longitudinal, observational studies of determinants of initiation and persistence of use of preventive drugs in older people. A particular focus is on the impact of common, symptomatic conditions, including depression, Parkinson disease, and chronic obstructive lung disease, on use of preventive therapies, including glaucoma drugs, bone resorption agents, and lipid-lowering drugs. Another evaluation will consider the relative use of drugs in the last year of life. Additional methodological aims will quantify the clustering of drug use within prescribers and evaluate alternative reference groups for studies of new users of specific medication classes. Studies will utilize administrative claims data from two large populations of persons aged 65 years or older: 1) over 500,000 older residents of Pennsylvania who had prescription drug coverage through that state's Pharmacy Assistance Contract for the Elderly (PACE) program between the years 1994 and 2005; and 2) all residents of British Columbia, including over 500,000 persons during the years 1995-2005, who received prescription benefits through that province's Pharmacare program. Data sources for these populations include: drug claims for all filled prescriptions; data on hospitalizations and outpatient visits including diagnoses; demographic information on patients and their prescribers; and information on program eligibility and mortality. These populations include large numbers of persons at particular risk for under-treatment including those aged 85 and above, women, blacks and those with multiple morbidities. Data analysis will use methods for longitudinal and clustered data to account for repeat prescriptions in the same people and to characterize the clustering of patients within prescribers. These studies are intended to advance methodologic strategies for evaluation of drug use and its effects in older people and to lay the foundation for interventions to improve prescribing in this population.