Implementation of a De-prescribing Medication Protocol to Evaluate Falls in Older Adults

摘要 拟议的研究将聘请医疗保健专业人员（HCP）筛查老年患者 有福尔斯的危险我们将使用防止老年人事故、死亡和伤害（STEADI）工具包 因此，所有HCP都可以识别有风险的患者， 医疗保健系统。这些患者将通过电子健康记录进行识别 (EHR)从医疗保健中心。65岁或以上的患者， 阿片类药物或苯二氮卓类药物（BZD）将纳入研究。这些诊所将参与 确定存在福尔斯风险的患者，教育患者福尔斯风险以及 阿片类药物或BZD药物，并实施取消处方药物方案， 多学科团队。先前的研究表明，阿片类药物和苯二氮卓类药物 这是最难管理的，也是最不可能导致变化的。鉴于该国的 目前的阿片类药物危机，我们的新方法将侧重于教育HCP如何使用去 这些药物在有福尔斯风险的老年人中的处方方案，包括替代方案 (and多学科）治疗方式和/或药物。这一拟议 研究将使用共享EHR记录STEADI筛选问题的答案。我们打算 创建专门针对福尔斯教育的协议以及关于取消特定处方的信息， BZD和阿片类药物，包括管理疼痛，失眠和/或焦虑的替代策略。 通过使用电子健康记录，我们将能够提供预防跌倒服务的转介， 在有以下风险的老年人中使用阿片类药物和BZD药物的取消处方方案 福尔斯。我们将能够采用替代（和多学科）治疗方式和/或 在必要的情况下用药。这项研究将确定影响有效性的因素， 采用、实施和维护以BZD为重点的取消处方计划， 阿片类药物，目的是减少福尔斯。这将使我们能够制定指导方针， 并在美国其他卫生系统实施类似的计划。

Abstract The proposed study will engage health care professionals (HCPs) to screen older adult patients at risk for falls. We will use the Stopping Elderly Accidents, Deaths and Injuries (STEADI) toolkit so all HCPs can identify patients at risk for falling within outpatient primary care clinics within the UNC Health Care System. These patients will be identified using an electronic health record (EHR) from UNC Health Care. Patients who are 65 years of age or older and taking either one opioid or benzodiazepine (BZD) will be included in the study. These clinics will engage the identified patients at risk for falls, educate patients on the risk of falls and injury posed by their opioid or BZD medication(s), and implement a de-prescribing medication protocol with a multidisciplinary team. Prior research indicates that opioid and benzodiazepine medications are among the most difficult to manage and least likely to result in a change. Given the country's current opioid crisis, our new approach will focus on educating HCPs on how to employ a de- prescribing protocol for these medications in older adults at risk for falls, incorporating alternate (and multidisciplinary) treatment modalities and/or medications where warranted. This proposed study will use a shared EHR to document answers to STEADI screening questions. We intend to create protocols specific to falls education as well as information about de-prescribing specific to BZDs and opioids, including alternate strategies for managing pain, insomnia, and/or anxiety. By using the EHR, we will be able to provide referral for fall prevention services beyond employing a de-prescribing protocol for opioid and BZD medications in older adults at risk for falls. We will be able to incorporate alternate (and multidisciplinary) treatment modalities and/or medications where warranted. This study will identify factors affecting the effectiveness, adoption, implementation, and maintenance of a de-prescribing program focused on BZDs and opioids with the intent of reducing falls. This will enable us to create guidelines for developing and implementing similar programs for other health systems across the United States.