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: 10268205
• 负责人: Michelle Anne Chui
• 金额: $ 48.76万
• 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/10268205
• 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.

项目摘要/摘要 老年人容易受到非处方药(OTC)药物安全问题的影响，这些问题和危害与 滥用。老年人不仅比其他年龄段的人更多地使用非处方药，而且他们的药物 选择往往不适合他们的年龄、健康状况或伴随的药物。他们也是 经常不遵守标签说明。100多万老年人面临着患严重不良反应的风险 涉及非处方药的药物事件。尽管老年人是AHRQ的优先人群，但没有 有效的干预措施广泛地试图减少该人群中非处方药滥用的危害。 跨学科团队，由药剂学、公共卫生、老年病学、人因工程、 生物统计、混合方法分析以及传播和实施，将与Advocate合作 Aurora Health(AAH)，一个拥有社区零售药店的大型医疗系统。此次合作将导致 系统重新设计干预措施(高级部分)的适应、采用和长期评估 减少63家AAH药店患者非处方药滥用。高级版块的特点包括 有计划地提供更安全的非处方药、警示标志和支持非处方药选择的工具，这些是 旨在方便老年人/药房工作人员接触非处方药问题。 EPIS(探索、准备、实施、维持)模型将成为概念框架 用于确保在应用于不同的药房设置时不断优化老年科。一种类型 2有效性-实施性混合设计将：(1)根据以下特点调整高级科 药房及其患者群体，(2)评估老年科减少老年人口的有效性 非处方药滥用，以及(3)评估最后确定的老年部分的实施情况。利用所获得的见解 来自药房工作人员、老年人和AAH利益相关者的老年科将使用眼球跟踪进行调整 技术和药剂师/技师面谈，以确定患者在选择非处方药时使用的功能 药物。这些成果将被用来为制定执行一揽子计划提供信息。为 有效性，试验后随机对照试验(比较试验和对照药房)将是 评估滥用非处方药的比率和药房工作人员/病人接触的特点。最终 在没有研究团队支持的情况下，AAH的实施将通过长期交付的保真度进行评估 有效性，以及对可持续性的看法，这提供了可持续的信号。 AAH领导层和一线药房员工致力于采用和评估这一创新技术 干预他们的药店。这项研究回应了AHRQ患者安全优先考虑的系统级别的变化 以改善药物使用情况。成果将解决AHRQ PA-20-028确定的未得到满足的关键需求，以 “传播以前在有限设置中使用的现有工具，从而能够改进 对于老年人来说，AHRQ针对的是非处方药滥用的高危人群。