Effect of Medication Management at Home via Pharmacy Home Televisits

老年人更有可能患有多种慢性疾病， 药物，更容易受到药物的不良影响。此外，老年人 成年人经常使用非处方药和补充剂，进一步使他们的 药物治疗复杂的药物治疗方案可能对老年人有害， 潜在的药物相互作用，潜在的不适当处方或非处方药使用， 以及可能导致慢性病控制不良的药物不依从性。干预措施 旨在减少门诊环境中的药物差异，例如审查 书面用药清单，并实施“棕色袋子”核对（要求患者 将所有药瓶带到诊所进行检查）仍然具有挑战性， 有限的成功。临床药师领导的干预措施，以改善适当的药物使用， 老年人，包括START/STOPP标准的应用，已经证明 有效减少药物不良事件。随着VA远程医疗能力的提高， 在家中与退伍军人联系，通过远程访问提供药物管理， 药剂师有可能为更多的老年退伍军人带来类似的好处。 远程医疗是VHA中越来越重要的组成部分，以增加访问和改善 护理质量。通过将护理扩展到实体诊所之外，远程医疗增加了 护理团队的覆盖范围更广，对患者更方便，从而改善患者的 满意利用远程医疗的能力，以达到病人的家，我们建议， 检验临床药师通过家庭视频远程访视进行用药管理的效果， 由于家庭视频访问有可能为老年人提供药物的直接可视化， 在成年人的家中，从而减少用药差异并增加用药依从性。 药剂师对老年人药物治疗方案的管理也可能得到适当的改善 通过直接的药剂师-患者访谈和教育，在老年人中使用药物。在 为了支持这一应用，我们研究小组的初步数据表明， 老年人视频远程访视的可接受性，患者和VA的吸收良好 提供商，并视频远程访问到家里是可行的。 在这项研究中，我们的目标是制定一个协议，药房家庭远程访视的药物 管理老年人谁有多种慢性疾病，并在多种 药物治疗然后，我们将进行一项混合有效性I型设计的随机试验， 检查这些远程访视对适当药物使用，药物差异， 遵守和药物不良事件，并观察和收集有关实施的信息。 我们预计，药剂师领导的药物管理家庭远程访问干预将导致 减少潜在的不适当用药， 差异，增加药物依从性和减少药物不良事件， 与接受常规护理的老年人相比。我们还将研究障碍， 促进者在实施干预，使研究结果可以告知未来 实施.

Older adults are more likely to suffer from multiple chronic conditions, to be prescribed multiple medications, and are more susceptible to adverse effects of medications. In addition, older adults often use over-the-counter medications and supplements, further complicating their medication regimen. Complex medication regimens are potentially harmful to older adults due to potential drug interactions, potentially inappropriate prescribing or over-the-counter drug use, and medication non-adherence that may lead to poor control of chronic disease. Interventions aimed at reducing medication discrepancy in the ambulatory clinic setting, such as the review of written medication lists, and implementation of “brown bag” reconciliation (asking patients to bring in all medication bottles for review in the clinic) continues to be challenging and have limited success. Clinical pharmacist led interventions to improve appropriate medication use in older adults, including the application of the START/STOPP criteria, have demonstrated effectiveness in reducing adverse drug events. With the increased capability of VA telemedicine to reach Veteran in their homes, delivering medication management via televisit by clinical pharmacists has the potential to yield similar benefits for a larger number of older Veterans. Telemedicine is an increasingly vital component within VHA to increase access and improve quality of care. By extending care beyond brick-and-mortar clinics, telemedicine increases the reach of care teams and is more convenient for patients, resulting in improved patient satisfaction. Using the capability of telemedicine to reach patients' homes, we propose to examine the effect of medication management by clinical pharmacists via home video televisits, as home video visits have the potential to provide direct visualization of medications in older adults' homes, thereby reducing medication discrepancy and increasing medication adherence. Pharmacist management for older adult medication regimen may also improve appropriate medication use in older adults through direct pharmacist-patient interview and education. In support of this application, preliminary data from our team of investigators demonstrate acceptability of video televisits by older adults, that there is good uptake by patients and VA providers, and that video televisits into the home are feasible. In this study, we aim to develop a protocol for pharmacy home televisits for medication management in older adults who have multiple chronic conditions and are on multiple medications. We will then conduct a randomized trial with hybrid effectiveness Type I design to examine the effect of these televisits on appropriate medication use, medication discrepancies, adherence and adverse drug events and observe and gather information on implementation. We anticipate that a pharmacist led medication management home televisit intervention will lead to reduction in potentially inappropriate use of medication, reduction in medication discrepancies, increased medication adherence and reduced adverse drug events in older adults compared to older adults receiving usual care. We will also examine the barriers and facilitators in implementing the intervention so that the study findings may inform future implementation.