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.

抽象的 这是Beeson的新兴职业发展奖（K76）的新兴领导者，马里兰州Rasheeda Hall博士 MBA，MHS。霍尔博士是一名肾脏科医生，在杜克大学进行老化研究，她的长期目标 是成为老年肾脏病的领导者，并制定针对老年病情的有效干预措施 在较老的透析患者中​​。与没有肾脏疾病的老年人相比，较老的透析患者更多 可能会出现严重的认知障碍，经历更多的跌倒，并且住院频率更高。 这些不良结果也已知与可能不适当的药物有关，并且较旧 透析患者非常容易受到潜在不适当药物的不良影响 由于缺乏肾功能和低血压和微型的常见出现而导致的药物清除改变了。 中风。鉴于这种敏感性，降低潜在不适当的药物是合乎逻辑的目标 改善这些脆弱患者的护理质量。霍尔博士提议的研究的目的是 制定一种基于证据的策略，以减少老年透析患者的不适当处方。 研究目的是：1）确定特定潜在不当药物的患病率以及程度 在普遍的老年透析患者中​​与住院风险有关联，2）确定元素 肾脏病医生，初级保健提供者和患者可接受的干预干预措施以及 3）确定针对老年透析患者量身定制干预措施的可行性。这项工作将 提供证据，以支持透析单元中排序的明确临床试验。有效的分类 干预措施有可能减少透析中的住院和改善老年综合症 与NIA的任务一致的患者。补充这项研究，这一职业发展 奖项将巩固霍尔博士通过课程和心理研究的过渡到研究独立性的过渡：a）填写 在指导一个统计学家团队，药物ePidemiologic数据的解释时，知识差距，高级 在观察数据中处理偏见的方法，及时定性分析，执行试验研究和 临床试验设计； b）提高她的领导能力； c）成功争夺R01。杜克大学是 霍尔博士追求这一研究职业发展的理想环境，因为衰老很强 研究专业知识位于其老龄化和会员胡椒中心中心，以及丰富的资源 可通过杜克的临床和转化学院获得。