Optimizing the Clinical Management of Polypharmacy for Children with Medical Complexity
优化医疗复杂性儿童多重用药的临床管理
基本信息
- 批准号:10656034
- 负责人:
- 金额:$ 40万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2023
- 资助国家:美国
- 起止时间:2023-04-01 至 2028-01-31
- 项目状态:未结题
- 来源:
- 关键词:
项目摘要
PROJECT SUMMARY/ABSTRACT
Optimal health for children with medical complexity (CMC) often depends on exposure to pediatric
polypharmacy (≥5 concurrent medications). Medication-related problems (MRPs), like inappropriate therapy,
undertreated symptoms, or adverse drug events, can lead to emergency visits or hospitalizations. Yet, during
routine clinical care for CMC, polypharmacy is infrequently assessed and rarely managed comprehensively. To
improve medication-related patient outcomes, safety, and value, a new approach is needed to manage
polypharmacy in the priority population of CMC. Pharmacist-led medication therapy management (MTM) is a
proven and effective tool for managing adult and geriatric polypharmacy. Our scientific premise is that a
structured pharmacist-led Pediatric Medication Therapy Management (pMTM) intervention will improve the
proactive management of polypharmacy by directly addressing major gaps in current practice. The
implementation of pMTM to address pediatric MRPs thus represents innovation based on an established
foundation. We propose a hybrid type 2 randomized controlled trial (RCT) of a pMTM intervention. This 5-year
study compares the effectiveness of a pMTM intervention to usual care for reducing the primary outcome of
MRPs, as well as the secondary outcomes of symptom burdens and acute healthcare utilization. In Aim 1, we
use a hybrid type 2 RCT to quantitatively measure reach and effectiveness of the pMTM intervention. We will
recruit CMC with polypharmacy and their parents within an academic center’s outpatient complex care
program that serves >5600 CMC annually. In Aim 2, we will quantitatively and qualitatively examine important
patient and parent characteristics that modify the effectiveness of the pMTM intervention. In Aim 3, we will
assess adoption, implementation, and potential for maintenance of the pMTM intervention by healthcare
providers, including program replication costs. The University of Colorado Anschutz Medical Campus provides
a unique research environment enabling the conduct of pediatric polypharmacy research, supported by
collaborative research partnerships between the Adult and Child Center for Health Outcomes Research and
Delivery Science (ACCORDS), the Skaggs School of Pharmacy and Pharmaceutical Sciences, and the
Children’s Hospital Colorado Special Care Clinic for children with medical complexity. Dr. James Feinstein, an
expert in pediatric complex care and polypharmacy research, will lead an experienced team of co-investigators
including, Dr. Allison Kempe (pragmatic trials and implementation science), Dr. Chris Feudtner (health services
and complex care research), Dr. Lucas Orth (pediatric pharmacy), Dr. John Rice (biostatistics and longitudinal
methods), Dr. Megan Morris (qualitative research), and Dr. Mark Gritz (economic analysis) to complete the
proposed research. If pMTM is proven effective, it could be rapidly disseminated nationally as a model for
pharmacist integration into outpatient complex care programs and it could have enormous impact on the public
health of CMC by preventing medication-related safety issues, attendant morbidity, and associated costs.
项目摘要/摘要
具有医学复杂性(CMC)的儿童的最佳健康状况通常取决于儿童暴露于
多种药物治疗(≥5种合并用药)。药物相关问题(MRP),如不适当的治疗,
治疗不足的症状或不良药物事件可能导致急诊或住院治疗。然而,在
CMC的常规临床护理,多种药物治疗很少被评估,也很少被全面管理。到
为了改善与药物相关患者结局、安全性和价值,需要一种新的方法来管理
在CMC的优先人群中使用多种药物。药剂师领导的药物治疗管理(MTM)是一个
已被证明是管理成人和老年人多种药物的有效工具。我们的科学前提是
结构化的药师领导的儿科药物治疗管理(pMTM)干预将改善
通过直接解决当前实践中的主要差距,积极主动地管理多种药物。的
因此,实施pMTM以解决儿科MRP代表了基于既定
基金会我们提出了一个混合型2随机对照试验(RCT)的pMTM干预。本5年
一项研究比较了pMTM干预与常规护理在减少主要结局方面的有效性。
MRPs,以及症状负担和急性医疗保健利用的次要结局。目标1:
使用混合2型RCT定量测量pMTM干预的覆盖范围和有效性。我们将
在学术中心的门诊综合护理中招募具有多种药物的CMC及其父母
每年为5600多名CMC提供服务。在目标2中,我们将定量和定性地研究重要的
改变pMTM干预有效性的患者和家长特征。在目标3中,我们
评估医疗保健部门采用、实施和维持pMTM干预的可能性
供应商,包括程序复制成本。科罗拉多大学安舒茨医学院提供
一个独特的研究环境,使儿科多药研究的行为,支持
成人和儿童健康结果研究中心之间的合作研究伙伴关系,
交付科学(ACCORDS),制药和制药科学的斯卡格斯学院,以及
儿童医院科罗拉多特殊护理诊所为儿童与医疗复杂性。詹姆斯·范斯坦博士,
儿科综合护理和多种药物研究方面的专家,将领导一个经验丰富的合作研究者团队
包括Allison Kempe博士(实用试验和实施科学)、Chris Feudtner博士(卫生服务
Lucas Orth博士(儿科药房),John Rice博士(生物统计学和纵向研究)
方法),Megan Morris博士(定性研究)和Mark Gritz博士(经济分析)来完成
提议的研究。如果pMTM被证明是有效的,它可以作为一种模式在全国范围内迅速传播,
药剂师整合到门诊复杂的护理计划,它可能会对公众产生巨大的影响,
通过预防药物相关的安全性问题、伴随的发病率和相关费用,来改善CMC的健康。
项目成果
期刊论文数量(0)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
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James A Feinstein其他文献
James A Feinstein的其他文献
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{{ truncateString('James A Feinstein', 18)}}的其他基金
Enhancing Medication Safety in Children with Polypharmacy Using Parent-Reported Symptom Assessments
使用家长报告的症状评估提高多药治疗儿童的用药安全
- 批准号:
10204066 - 财政年份:2017
- 资助金额:
$ 40万 - 项目类别:
Enhancing Medication Safety in Children with Polypharmacy Using Parent-Reported Symptom Assessments
使用家长报告的症状评估提高多药治疗儿童的用药安全
- 批准号:
9293759 - 财政年份:2017
- 资助金额:
$ 40万 - 项目类别:
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