Medication changes in hospitalized older adults

住院老年人的药物变化

• 批准号: 9903238
• 负责人: MICHAEL A. STEINMAN
• 金额: $ 18.27万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-04-01 至 2021-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9903238
• 关键词: Accident and Emergency department; Address; Adherence; Admission activity; Adverse drug event; Age; Aging; Area; Attention; Biological Models; Blood Pressure; Chronic; Chronic Disease; Clinical; Communication; Communities; Complex; Confusion; Control Groups; Data; Databases; Development; Diabetes Mellitus; Disease; Elderly; Emergency department visit; Epidemiology; Faculty; Fostering; Frequencies; Funding; Glucose; Goals; Healthcare Systems; Hospitalization; Hospitals; Hypertension; Inpatients; K-Series Research Career Programs; Laboratories; Lead; Length of Stay; Linear Models; Medical center; Medicare; Medication Errors; Medicine; Mentors; Mentorship; Methods; Modification; Outcome; Patients; Pharmaceutical Preparations; Pharmacotherapy; Pneumonia; Polypharmacy; Practice Guidelines; Regimen; Research; Research Personnel; Research Support; Residencies; Resources; Retrospective cohort; Serum; Time; Training Programs; Urinary tract infection; Veterans; Work; adverse drug reaction; compliance behavior; functional disability; glycemic control; hospital readmission; hypertension control; improved; medication compliance; multiple chronic conditions; older patient; overtreatment; patient oriented; public health relevance; venous thromboembolism

DESCRIPTION (provided by applicant): Background: When older adults are hospitalized, they are often discharged on substantially different medication regimens than the ones they were using prior to admission. In this setting, errors of medication reconciliation and problems with medication adherence are common. To address these problems, much effort has focused on improving medication reconciliation and communication at the time of discharge. However, little attention has been paid to the medication changes themselves that happen during the hospital stay. These changes are often inappropriate, and can lead to medication confusion, non-adherence, and adverse drug reactions in the weeks and months after hospital discharge. This is particularly important for chronic diseases such as hypertension and diabetes, as medicines for these conditions may often be changed during the hospital stay and perpetuated at discharge despite having little relation to the reason for admission. Aims: (1) To determine the frequency and epidemiology of changes to medication regimens for hypertension and diabetes in older adults admitted to VA hospitals; (2) To evaluate the impact of these medication changes on medication persistence and adherence in the year after discharge; and (3) To evaluate the association between changes to chronic medications during the hospital stay and subsequent emergency department visits and hospital readmissions. Methods: Using national data from VA and Medicare, we will assemble a retrospective cohort of veterans age 65 years and older who had hypertension or diabetes and were hospitalized in a VA medical center with community-acquired pneumonia, urinary tract infection, or venous thromboembolism. (These conditions were chosen because they are common and are treated with a different set of medications than those used to manage hypertension and diabetes). Using claims data and targeted chart review, we will identify 500 patients who were discharged on more aggressive regimens for blood pressure and/or glycemic control than they were receiving prior to admission, and a control group of 500 patients without intensified regimens. We will use standard methods to evaluate persistence of and adherence to medications in the year after hospital discharge. We will use Cox regression and mixed effects generalized linear models to compare medication persistence and adherence in patients who were discharged from the hospital with a more intensive medication regimen vs. patients whose medication regimens were not intensified. We will use similar methods to determine the impact of medication changes during hospitalization on subsequent emergency department use and hospital readmission.

描述（由申请人提供）： 背景：当老年人住院时，他们出院时通常采用与入院前使用的药物方案截然不同的药物方案。在这种情况下，药物协调错误和药物依从性问题很常见。为了解决这些问题，人们付出了很多努力来改善出院时的药物协调和沟通。然而，很少有人关注住院期间发生的药物变化本身。这些改变往往是不恰当的，并可能导致出院后数周和数月内用药混乱、不依从和药物不良反应。这对于高血压和糖尿病等慢性疾病尤其重要，因为治疗这些疾病的药物通常可能在住院期间更换，并在出院时继续使用，尽管与入院原因关系不大。目的：(1) 确定退伍军人事务部医院收治的老年人高血压和糖尿病药物治疗方案改变的频率和流行病学； (2) 评估这些药物变化对出院后一年内药物持续性和依从性的影响； (3) 评估住院期间慢性药物变化与随后的急诊就诊和再入院之间的关联。方法：利用 VA 和 Medicare 的全国数据，我们将收集 65 岁及以上患有高血压或糖尿病并因社区获得性肺炎、尿路感染或静脉血栓栓塞在 VA 医疗中心住院的退伍军人的回顾性队列。 （选择这些病症是因为它们很常见，并且使用与治疗高血压和糖尿病不同的药物进行治疗）。利用理赔数据和有针对性的图表审查，我们将确定 500 名患者出院后接受了比入院前更积极的血压和/或血糖控制方案，以及 500 名未接受强化方案的患者作为对照组。我们将使用标准方法来评估出院后一年内药物的持久性和依从性。我们将使用 Cox 回归和混合效应广义线性模型来比较出院时接受更强化药物治疗的患者与未强化药物治疗的患者的药物持久性和依从性。我们将使用类似的方法来确定住院期间药物变化对随后急诊室使用和再次入院的影响。