Implementation of a Medication Care Plan to Reduce Unintentional Injury among Rural Older Adults

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PROJECT ABSTRACT Falls are the leading cause of unintentional fatal and nonfatal injury among older adults in the United States. In Iowa, rates of fall-related deaths and hospitalizations among older adults are higher than the national average. More than one-third of older adults fall each year in the U.S., and many of these falls result in injury, decreased or permanent loss of functioning, loss of independence and a fear of falling. We know that certain medications, including those that affect the central nervous system (CNS), increase the risk of a fall among older adults and that interventions targeting withdrawal of these medications reduce falls and fall-related injuries. We also know that reaching high-risk older adults, including those living in rural communities, with falls prevention programs can be challenging. On their own, older adults do not typically engage in falls prevention behaviors and often report that limited support from healthcare providers is a barrier to participation in falls prevention programs. The long-term goal of the proposed study is to develop a sustainable program for healthcare systems to reduce fatal and nonfatal falls among high-risk older adults living independently in their communities. The objective of the proposed study is to examine how a medication care plan, grounded in established medication de-prescribing and tapering frameworks, can be implemented in primary care clinics to reduce medically-treated falls among older adults living in rural Iowa communities. The proposed study is a collaboration between researchers and clinical pharmacists at the University of Iowa and a clinical team from the Mercy Health Network Accountable Care Organization (ACO), which is a non-academic healthcare system with significant reach into rural Iowa communities. Leveraging an existing partnership with the Mercy ACO, we will use an effectiveness-implementation hybrid design to accomplish the following specific aims: (1) Examine the effectiveness of a clinic-based, individualized medication care plan in reducing rates of medically treated falls (sub-aim 1a) and motor vehicle charges and crashes (sub-aim 1b) among older adults seen in rural primary care clinics, (2) Identify provider and patient factors that are associated with patient adherence to medication deprescribing and discontinuation recommendations, and (3) Evaluate implementation of the medication care plan to understand its acceptability, usability and relevance among healthcare system administrators, clinics (clinic managers and clinical staff), providers (health coaches, pharmacists, prescribers) and patients. Accomplishing these aims will result in a framework for how individualized medication care plans, developed to reduce medically treated falls among older adults, can be effectively disseminated through a healthcare system and implemented by older adults.