Improving the Quality of Medication Use in Older Adults

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DESCRIPTION (provided by applicant): The long-term goal of the applicant is to become an independent investigator who designs, implements, and rigorously evaluates a medication management program to improve the quality of medication use for older adults in the community setting. Older adults are at risk of developing medication-related problems that: (1) increase morbidity, health services utilization, and death and (2) compromise health status and quality of life. Traditionally, efforts target isolated medication-related problems as independent events, overlooking the interdependency of such events in a person as well as important interactions among these events. However, given the complexity of older adults' medication regimens, a patient-centered approach that addresses all medication-related problems that are present in an individual may be more effective. The program developed will seek to involve clinical pharmacists as team members to improve the quality of medication use for older adults. To accomplish this, three specific aims are proposed. In Specific Aim 1, a 1-year cohort study will be conducted to estimate the prevalence and incidence of drug therapy problems experienced by elders in the community setting as well as the persistence of unresolved problems over time. Aim 1 will also examine the relationship of race to the number and type of drug therapy problems. In Specific Aim 2, qualitative methodologies, using semi-structured interviews developed from information obtained in Aim 1, will be used to identify facilitators of, and barriers to, quality medication use from the perspectives of patients, physicians, and pharmacists. In Specific Aim 3, results from studies conducted in Specific Aims 1 and 2 will be incorporated into the design of a medication management program that will be implemented and tested to improve the quality of medication use. By the conclusion of this award, a grant application will be submitted to conduct a randomized trial to rigorously evaluate the final program. The proposed career development plan capitalizes on the rich environment at the UNC Schools of Public Health, Pharmacy, Nursing, and Medicine. The primary co-mentors on this application are experienced researchers and mentors with a particular interest in quality medication use and increasing clinical pharmacists' roles as members of health care teams; their complementary backgrounds will serve the applicant well. Commitments from outstanding advisors will further assist the applicant in the research and career development plans. The career development plan has been carefully developed to include didactic courses in advanced quantitative analysis, health policy, and program planning as well as seminars and mentoring to foster the research skills of the applicant.