Deprescribing for Older Dialysis Patients

取消老年透析患者的处方

• 批准号: 9925719
• 负责人: Rasheeda K Hall
• 金额: $ 22.12万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-01 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9925719
• 关键词: Address; Adrenergic alpha-Antagonists; Adverse effects; Adverse event; Affect; Aging; Agonist; Antihypertensive Agents; Area; Attitude; Award; Capsicum; Caregivers; Caring; Categories; Cerebrovascular Disorders; Client satisfaction; Clinical; Clinical Trials; Clinical Trials Design; Communities; Data; Decision Making; Dialysis patients; Dialysis procedure; Diffusion of Innovation; Elderly; Elements; End stage renal failure; Environment; Face; Focus Groups; Frequencies; Future; Goals; Health; Health system; Hospitalization; Hypotension; Impaired cognition; Individual; Information Systems; Institutes; Intervention; Interview; K-Series Research Career Programs; Kidney; Kidney Diseases; Knowledge; Lead; Leadership; Medicare; Mental Depression; Mentors; Methods; Mission; Nephrology; Opioid; Outcome; Patient Preferences; Patients; Pattern; Pharmaceutical Preparations; Pharmacists; Pharmacoepidemiology; Physicians; Physiological; Pilot Projects; Predisposition; Prevalence; Provider; Quality of Care; Quality of life; Registries; Renal function; Research; Research Design; Resources; Risk; Scientist; Stroke; Structure; Syndrome; Testing; Time; United States; Universities; Vocational Guidance; Withdrawal; Work; adverse outcome; beneficiary; care providers; career development; case-based; cognitive function; cohort; contextual factors; design; effective intervention; effectiveness evaluation; evidence base; experience; falls; health care quality; health care service utilization; hospitalization rates; improved; leadership development; novel; patient engagement; preference; primary outcome; recruit; research study; shared decision making; skill acquisition; skills; standard of care; theories

ABSTRACT This is a Beeson Emerging Leaders in Aging career development award (K76) for Dr. Rasheeda Hall, MD, MBA, MHS. Dr. Hall is a nephrologist who conducts aging research at Duke University, and her long-term goal is to become a leader in geriatric nephrology and develop effective interventions targeting geriatric conditions in older dialysis patients. Compared to older adults without kidney disease, older dialysis patients are more likely develop severe cognitive impairment, experience more falls, and have more frequent hospitalizations. These adverse outcomes are also known to be associated with potentially inappropriate medications, and older dialysis patients are highly susceptible to adverse effects of potentially inappropriate medications because of altered medication clearance due to absent kidney function and common occurrences of hypotension and mini- strokes. Given this susceptibility, reduction of potentially inappropriate medications is a logical goal for improving quality of care for these vulnerable patients. The objective of Dr. Hall’s proposed research is to develop an evidence-based strategy to reduce inappropriate prescribing in older dialysis patients. The research aims are to: 1) identify the prevalence of specific potentially inappropriate medications and the extent to which there is an association with hospitalization risk in prevalent older dialysis patients, 2) identify elements of a deprescribing intervention that are acceptable to nephrologists, primary care providers, and patients, and 3) determine the feasibility of a deprescribing intervention tailored for older dialysis patients. This work will provide evidence to support a definitive clinical trial of deprescribing in dialysis units. Effective deprescribing interventions have the potential to reduce hospitalizations and ameliorate geriatric syndromes in dialysis patients which is consistent with NIA’s mission. Complementary to this research, this career development award will solidify Dr. Hall’s transition to research independence through coursework and mentoring to: a) fill knowledge gaps in directing a team of statisticians, interpretation of pharmacoepidemiologic data, advanced methods in handling bias in observational data, timely qualitative analyses, execution of a pilot study, and clinical trial design; b) enhance her leadership skills; and c) successfully compete for a R01. Duke University is the ideal environment for Dr. Hall to pursue this research career development because of the strong aging research expertise housed in its Center for Aging and affiliated Pepper Center, as well as, rich resources available through Duke’s Clinical and Translational Institute.

摘要 这是一个Beeson新兴领导人在老龄化职业发展奖（K76）博士Rasheeda大厅，医学博士， 工商管理硕士MHS霍尔博士是一位肾病学家，在杜克大学进行衰老研究，她的长期目标是 是成为老年肾病学的领导者，并针对老年疾病制定有效的干预措施 在老年透析患者中。与没有肾脏疾病的老年人相比，老年透析患者 可能发展为严重的认知障碍，经历更多的福尔斯，并有更频繁的住院治疗。 这些不良结果也与潜在的不适当的药物治疗有关， 透析患者对潜在的不适当药物的副作用高度敏感， 由于肾功能缺失以及常见的低血压和迷你血压而导致药物清除率改变 中风鉴于这种易感性，减少潜在的不适当药物是一个合乎逻辑的目标， 改善这些弱势患者的护理质量。霍尔博士提出的研究目标是 制定循证策略，减少老年透析患者的不适当处方。的 研究的目的是：1）确定特定的潜在不适当的药物的患病率和程度， 与普遍的老年透析患者的住院风险相关，2）识别要素 肾脏科医生、初级保健提供者和患者可接受的取消处方干预，以及 3)确定为老年透析患者量身定制的取消处方干预的可行性。这项工作将 提供证据以支持在透析单位取消处方的明确临床试验。有效地取消处方 干预措施有可能减少透析中的住院率并改善老年综合征 这与NIA的使命一致。作为这项研究的补充， 该奖项将通过课程和指导巩固霍尔博士向研究独立的过渡，以：a）填补 指导统计学家团队的知识差距，药物流行病学数据的解释，高级 处理观察数据偏倚的方法，及时的定性分析，试点研究的执行，以及 临床试验设计; B）增强她的领导能力;以及c）成功竞争R01。杜克大学是 由于老龄化严重，这是Hall博士从事研究职业发展的理想环境 其老龄化中心和附属的胡椒中心拥有研究专长，以及丰富的资源 可通过杜克临床和转化研究所获得。