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

• 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
• 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

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)：理由：药品不良反应(ADR)在门诊老年人中很常见，而且往往很严重。然而，人们对脆弱等经典的“老年特征”如何影响ADR风险知之甚少，也很少有临床上有用的工具来量化个别老年人的ADR风险。 研究目标/目的：我们的目标是(1)确定老年人药物不良反应的危险因素，特别关注包括身体、认知和社会脆弱性在内的老年特征；(2)开发和验证用于评估老年人ADR风险的预测工具；以及(3)使用临床医生焦点小组和访谈来完善和试点基于ADR风险预测指数的干预措施。在比森奖期结束时，我们将提交一份R01拨款提案，以测试这种干预。 方法：我们将聚集并跟踪从旧金山两家医院出院的400名老年人的预期队列。通过系列电话访问和图表审查，我们将使用经过验证的方法来识别和描述药物不良反应，并收集关于各种潜在风险因素的信息。对于AIM(3)，我们将进行焦点小组和结构化认知访谈，以完善并试行基于ADR风险指数的干预。 分析：对于目标1，我们将使用混合努力泊松回归来确定ADRs的危险因素。对于目标2，我们将使用标准技术来开发和验证ADRs的风险预测指数。对于目标3，我们将使用定性技术来分析焦点小组和采访记录的相关内容。 与公共卫生相关：量化老年人的ADR风险可以改善临床护理，方法是帮助临床医生权衡药物治疗的利弊，并针对高危老年人进行基于系统的干预，以减少ADR和改善处方。这项拟议的研究将获得数据，以支持未来的干预研究，其目标是减少ADR并改善老年人的处方。