Guideline Adherence in Elders With Multiple Comorbidities

患有多种合并症的老年人遵守指南的情况

基本信息

批准号：
7554534
负责人：
MICHAEL A. STEINMAN
金额：
$ 11.88万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2008
资助国家：
美国
起止时间：
2008-09-30 至 2011-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7554534
关键词：
Accounting Adverse drug effect Adverse effects Adverse event Adverse reactions Age Aging Applications Grants Attitude Award Cardiovascular system Caring Characteristics Clinic Clinical Clinical Trials Cognitive Cohort Studies Comorbidity Condition Data Development Disease Disease regression Drug Prescriptions Elderly Enrollment Equilibrium Event Focus Groups Foundations Future Goals Group Structure Guideline Adherence Hand Hospitals Impaired cognition Impairment Individual Intervention Intervention Studies Interview Knowledge Life Measurement Measures Methods Morbidity - disease rate Numbers Patient Care Patients Persons Pharmaceutical Cares Pharmaceutical Preparations Pharmacists Pharmacotherapy Physicians Prevention Process Public Health Reaction Research Research Personnel Risk Risk Factors Risk Reduction Running San Francisco Score Services Social support Standards of Weights and Measures System Techniques Telephone Interviews Testing Time Transcript Translating Validation age related base career cohort design experience follow-up frailty improved improved functioning indexing insight instrument mortality prevent programs prospective skills social tool

项目摘要

DESCRIPTION (provided by applicant): Rationale: Adverse drug reactions (ADRs) are common and often severe in ambulatory elders. However, little is known about how classically "geriatric1 features such as frailty impact ADR risk, and few clinically- useful tools exist to quantify the risk of ADRs in individual older persons. Research objectives / aims: Our aims are (1) to determine risk factors for adverse drug reactions in elders, with a particular focus on geriatric features including physical, cognitive, and social vulnerability; (2) to develop and validate a prediction tool to assess ADR risk in elders; and (3) to use clinician focus groups and interviews to refine and pilot test an intervention based on the ADR risk prediction index. At the conclusion of the Beeson Award period, we will submit a R01 grant proposal to test this intervention. Methods: We will assemble and follow a prospective cohort of 400 elders following discharge from two San Francisco hospitals. Through serial telephone interviews and chart review, we will use validated methods to identify and characterize adverse drug reactions and to collect information on a variety of potential risk factors. For Aim (3), we will conduct focus groups and structured cognitive interviews to refine and then pilot test an intervention based on the ADR risk index. Analyses: For Aim 1, we will use mixed-efforts Poisson regression to determine risk factors for ADRs. For Aim 2, we will use standard techniques to develop and validate a risk prediction index for ADRs. For Aim 3, we will use qualitative techniques to analyze focus group and interview transcripts for relevant content. Relevance to public health: Quantifying ADR risk in elders can improve clinical care by helping clinicians weigh the benefits vs. harms of drug therapy and by targeting high-risk elders for systems-based interventions to reduce ADRs and improve prescribing. The proposed research will obtain data to support a future intervention study whose goal is to reduce ADRs and improve prescribing for elders.

描述（由申请人提供）：基本原理：不良药物反应（ADR）很常见，并且在门诊长老中通常很严重。但是，对于“脆弱的影响ADR风险）以及临床上有用的工具几乎没有什么来量化单个老年人中ADR的风险，几乎没有什么知识。研究目标 /目的：我们的目的是（1）确定长者不良药物反应的危险因素，特别关注老年病特征，包括身体，认知和社会脆弱性；（2）开发和验证一种评估长者中ADR风险的预测工具；（3）使用临床医生焦点小组和访谈来完善和试点测试基于ADR风险预测指数的干预措施。在Beeson奖项期结束时，我们将提交一项R01赠款建议，以测试此干预措施。方法：在两家旧金山医院出院后，我们将组装并遵循400名长辈的预期队列。通过串行电话访谈和图表审查，我们将使用经过验证的方法来识别和表征不良药物反应并收集有关各种潜在危险因素的信息。对于AIM（3），我们将进行焦点小组和结构化认知访谈以完善，然后根据ADR风险指数测试干预措施。分析：对于AIM 1，我们将使用混合级泊松回归来确定ADR的危险因素。对于AIM 2，我们将使用标准技术来开发和验证ADR的风险预测指数。对于AIM 3，我们将使用定性技术来分析相关内容的焦点小组和访谈笔录。与公共卫生的相关性：量化长老中的ADR风险可以通过帮助临床医生权衡药物治疗的益处，并针对基于系统的干预措施的高风险长者来改善临床护理，以减少ADR并改善处方。拟议的研究将获取数据以支持将来的干预研究，该研究的目标是减少ADR并改善长者的处方。