Reducing Polypharmacy and Fall Risk for Multi-Morbid Adults with Chronic Obstructive Pulmonary Disease

点击翻译按钮获取中文摘要

Project summary Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality in the US and results in significant reduction in quality of life and functional status. Patients with COPD are 55 times more likely to fall than patients without COPD, putting these patients at high risk of fall-related injuries and further decrements in quality of life and health. This study will tackle the common and important problem of use of fall- risk increasing drugs (FRIDs) among patients with COPD. This will be achieved by implementing and evaluating a pharmacist-led deprescribing intervention to reduce FRIDs use among community-dwelling, multi- morbid adults with COPD. The central hypothesis of this proposal is that poor communication and limited shared decision making between prescribers, patients, and patient caregivers represent modifiable barriers to deprescribing. Once these barriers are addressed, prescribers, patients and caregivers will be amenable to informed deprescribing as part of this targeted intervention. In Specific Aim 1, I will use a national database to assess commonly used FRIDs among patients with COPD, identifying FRID types and combinations associated with the highest fall risk. In Specific Aim 2, I will interview patients with COPD, their family caregivers, and clinicians (primary care providers, pulmonologists, pharmacists) to elicit barriers, facilitators and key strategies to deprescribing FRIDs and enhancing shared decision making between clinicians and patients. In Specific Aim 3, I will conduct a pilot randomized trial, testing a pharmacist-led deprescribing intervention, adapted using findings from Specific Aims 1 and 2. I will evaluate the feasibility, acceptability and appropriateness of the intervention using semi-structured interviews and structured questionnaires. I will also explore the preliminary efficacy of the intervention compared to usual care for the primary outcome of FRID discontinuation. This pilot trial will provide preliminary data for a future R01-funded hybrid effectiveness- implementation trial. This research is innovative in that: 1) no prior study has evaluated an intervention to facilitate deprescribing FRIDs among patients with COPD; 2) this intervention includes family caregivers, who provide informal medication management to patients; and 3) this project uses a pulmonary clinic-based pharmacist as a conduit to improve communication and shared decision making among patients, caregivers and clinicians. My learning objectives are to learn a) advanced statistical methods to evaluate fall risk among patients with COPD, b) training on COPD therapeutics and fall risk assessment, c) behavioral intervention optimization, adaptation and assessment, and d) behavioral clinical trials design for future intervention trials. My long-term career goals are to evaluate and disseminate evidence-based interventions to improve medication management and healthcare delivery for multi-morbid adults with COPD.