Optimal Medication Management in Alzheimer's Disease and Dementia

阿尔茨海默病和痴呆症的最佳药物管理

• 批准号: 9897518
• 负责人: ELIZABETH A BAYLISS
• 金额: $ 62.34万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-30 至 2022-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9897518
• 关键词: Activities of Daily Living; Adverse drug effect; Adverse drug event; Age; Alzheimer' s Disease; Alzheimer' s disease related dementia; Caregivers; Caring; Chronic; Clinic; Clinical; Colorado; Complex; Data Reporting; Decision Making; Dementia; Drug Interactions; Effectiveness of Interventions; Elderly; Electronic Health Record; Family; Family Caregiver; Fostering; Goals; Guidelines; Health; Health system; Heart Diseases; Hospitals; Hypertension; Incontinence; Individual; Integrated Delivery Systems; Intervention; Interview; Length; Medication Management; Medicine; Morbidity - disease rate; Office Visits; Outcome; Outpatients; Patient-Focused Outcomes; Patients; Persons; Pharmaceutical Preparations; Pharmacy facility; Phase; Phased Innovation Awards; Polypharmacy; Population; Pragmatic clinical trial; Prevalence; Primary Health Care; Process; Randomized; Regimen; Research; Risk; Risk-Taking; Skilled Nursing Facilities; System; Testing; Vulnerable Populations; base; clinical practice; cognitive change; comorbidity; design; effectiveness testing; falls; health care delivery; hospitalization rates; improved; improved outcome; intervention effect; mortality; multiple chronic conditions; outcome forecast; patient oriented; patient safety; pragmatic trial; primary outcome; secondary outcome; side effect

PROJECT SUMMARY: The vast majority of individuals with Alzheimer's disease and related dementias (ADRD) have multiple chronic conditions (MCC). The combination of ADRD plus other conditions (ADRD-MCC) leads to more medication use, more complex medication regimens for patients, and is associated with greater risk of adverse drug events, drug interactions, treatment burden and cognitive changes in addition to higher rates of hospitalization and mortality. Optimizing medication through deprescribing (the process of reducing or stopping the use of inappropriate medications or medications unlikely to be beneficial) can help avoid adverse drug effects and improve outcomes for MCC patients, particularly for those with ADRD. Deprescribing is a nascent field in the U.S. that is likely to have a significant positive impact over the next decade if properly developed and implemented. We propose a project to refine and test a pragmatic deprescribing intervention for people with ADRD-MCC so that these patients are on “just right” medication regimens. Our overall goal for the project is to refine and test a patient- and family/caregiver- centric deprescribing intervention that is applicable to multiple medications and can be adapted to a variety of healthcare delivery settings. The intervention will target older adults with ADRD-MCC on 5 or more medications and their family caregivers and deliver the intervention at Kaiser Permanente Colorado (KPCO), a not-for-profit integrated delivery system. Aims 1 and 2 will focus on engaging patients, family/ caregivers, clinicians and health system stakeholders to enhance, refine, and pilot test the intervention. Aims 3 and 4 will test the effectiveness of the intervention in reducing number of chronic medications and number of potentially in appropriate medications as well secondary outcomes of patient falls, adverse drug events, hospital and skilled nursing facility utilization, activities of daily living, and outpatient office visit length. Aim 5 will qualitatively explore mechanisms behind intervention effectiveness. The proposed project will demonstrate the potential to implement sustainable changes in medication management to improve the health and safety of patients with ADRD receiving treatment for comorbid conditions with multiple medications. It will be adaptable to other delivery systems and settings, and is designed to foster a culture of thoughtful medication decision-making acceptable to ADRD-MCC patients, caregivers, and their clinicians.

项目概要： 绝大多数患有阿尔茨海默病和相关痴呆（ADRD）的个体具有多个慢性疾病。 条件（MCC）。ADRD+其他疾病（ADRD-MCC）的组合导致更多药物 使用时，患者的用药方案更加复杂，并且与更大的药物不良风险相关 事件、药物相互作用、治疗负担和认知变化，以及住院率升高 and mortality.通过取消处方优化药物治疗（减少或停止使用 不适当的药物或药物不太可能是有益的）可以帮助避免不良药物作用， 改善MCC患者结局，尤其是ADRD患者。取消处方是一个新兴领域， 美国如果得到适当的发展，这可能会在未来十年产生重大的积极影响， 切实贯彻我们提出了一个项目，以完善和测试一个务实的取消处方干预的人， ADRD-MCC，以便这些患者接受“恰到好处”的药物治疗方案。我们的项目总体目标是 完善和测试以患者和家庭/护理人员为中心的取消处方干预措施， 它可以用于药物治疗，并且可以适应各种医疗保健提供环境。 该干预措施将针对接受5种或更多种药物治疗的ADRD-MCC老年人及其家庭护理人员 并在Kaiser Permanente科罗拉多（KPCO）提供干预，这是一个非营利的综合提供系统。 目标1和2将侧重于让患者、家庭/护理人员、临床医生和卫生系统利益相关者参与， 加强、完善和试点测试干预措施。目标3和4将检验干预措施的有效性， 减少慢性药物的数量以及潜在的适当药物的数量 患者福尔斯、药物不良事件、医院和专业护理机构利用率的次要结局， 日常生活活动和门诊就诊时间。Aim 5将定性地探索 干预效果。 拟议的项目将展示实施药物可持续变化的潜力 管理以改善接受共病治疗的ADRD患者的健康和安全性 与多种药物的条件。它将适用于其他交付系统和设置， 旨在培养ADRD-MCC患者可接受的深思熟虑的药物决策文化， 护理人员和他们的临床医生。