Effectiveness and Sustainment of a Tailored Over-the-Counter Medication Safety Intervention in Community Pharmacies

社区药房量身定制的非处方药安全干预措施的有效性和持续性

• 批准号: 10088144
• 负责人: Michelle Anne Chui
• 金额: $ 49.96万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-30 至 2023-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10088144
• 关键词: Effectiveness; Sustainment; Tailored; Over; Counter

Project Summary/Abstract Older adults are susceptible to over-the-counter (OTC) medication safety issues and harms related to misuse. Not only do older adults use OTC medications more than other age groups, but their medication selection often is not appropriate for their age, health conditions, or concomitant medications. They also are frequently non-compliant with labeling instructions. Over 1 million older adults are at risk for a major adverse drug event that involves an OTC medication. Although older adults represent an AHRQ priority population, no effective interventions have broadly attempted to decrease OTC medication misuse harms in this population. The transdisciplinary team, with experts in pharmacy, public health, geriatrics, human factors engineering, biostatistics, mixed-methods analysis, and dissemination and implementation, will collaborate with Advocate Aurora Health (AAH), a large health system with community retail pharmacies. This collaboration will lead to the adaptation, adoption, and long-term evaluation of a system redesign intervention (the Senior Section) to decrease OTC medication misuse for patients in 63 AAH pharmacies. Senior Section features include a curated supply of safer OTC medications, cautionary signage, and tools to support OTC selection, which are designed to facilitate older adult/pharmacy staff encounters about OTC issues. The EPIS (Exploration, Preparation, Implementation, Sustainment) model will be the conceptual framework used to ensure continual optimization of the Senior Section when applied to varied pharmacy settings. A Type 2 effectiveness-implementation hybrid design will: (1) adapt the Senior Section based on characteristics of pharmacies and their patient population, (2) evaluate Senior Section effectiveness for reducing older adult OTC medication misuse, and (3) evaluate implementation of the finalized Senior Section. Using insights gained from pharmacy staff, older adult, and AAH stakeholders, the Senior Section will be adapted using eye-tracking technology and pharmacist/technician interviews to identify features that patients use when selecting OTC medications. These outcomes will be used to inform the development of an Implementation Package. For effectiveness, a post-test randomized controlled trial (comparing test and control pharmacies) will be conducted to evaluate the rate of OTC misuse and characteristics of pharmacy staff/patient encounters. Final implementation by AAH without research team support will be assessed by fidelity of delivery, long-term effectiveness, and perceptions about sustainability, which provide a signal of sustainment. AAH leadership and front-line pharmacy staff are committed to adopting and evaluating this innovative intervention in their pharmacies. This study responds to AHRQ patient safety priorities for system-level change to improve medication use. Outcomes will address an unmet critical need, identified by AHRQ PA-20-028, to “spread existing tools that have previously been used in limited settings, and thus enabling improvement on a larger scale” for older adults, an AHRQ targeted population at high risk for OTC medication misuse.

项目总结/摘要 老年人容易受到非处方（OTC）药物安全性问题和与以下方面相关的伤害 误用老年人不仅比其他年龄组更多地使用OTC药物， 选择通常不适合他们的年龄、健康状况或伴随药物。他们也是 经常不遵守标签说明。超过100万老年人面临重大不良反应的风险， 涉及OTC药物的药物事件。虽然老年人是AHRQ的优先群体，但 有效的干预措施已广泛尝试减少OTC药物滥用对这一人群的危害。 这个跨学科的团队，由药学、公共卫生、老年医学、人为因素工程、 生物统计、混合方法分析、传播和实施，将与倡导者合作 Aurora Health（AAH）是一个拥有社区零售药店的大型卫生系统。这一合作将导致 系统重新设计干预（高级部分）的适应、采用和长期评估， 减少63家AAH药店患者的OTC药物滥用。高级部分的功能包括 策划供应更安全的OTC药物、警示标志和支持OTC选择的工具， 旨在帮助老年人/药房工作人员了解OTC问题。 EPIS（勘探、准备、实施、维持）模式将是概念框架 用于确保在应用于不同药房环境时持续优化高级部分。一种 2有效性-实施混合设计将：（1）根据 药房及其患者人群，（2）评估老年科减少老年人的有效性 OTC药物滥用，（3）评估最终确定的高级部分的执行情况。利用获得的见解 从药房工作人员，老年人，和AAH利益相关者，高级部分将采用眼动追踪 技术和药剂师/技术人员访谈，以确定患者在选择OTC时使用的功能 药物治疗这些成果将用于为制定一揽子执行计划提供信息。为 有效性，测试后随机对照试验（比较测试和对照药店）将 评价OTC滥用率和药房工作人员/患者接触的特征。最终 在没有研究团队支持的情况下，AAH的实施将通过交付的保真度、长期 有效性，以及对可持续性的看法，这提供了一个可持续的信号。 AAH领导层和一线药房工作人员致力于采用和评估这一创新的 干预他们的药房。本研究响应了系统级变更的AHRQ患者安全优先级 改善药物使用。成果将解决AHRQ PA-20 - 028确定的未满足的关键需求， "推广以前在有限环境中使用的现有工具，从而能够改进 对于老年人，AHRQ针对OTC药物滥用高风险人群。