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

项目摘要 福尔斯是美国老年人意外致命和非致命伤害的主要原因。在 在爱荷华州，老年人与跌倒有关的死亡率和住院率高于全国平均水平。 在美国，每年有超过三分之一的老年人摔倒，许多福尔斯摔倒导致受伤， 或永久丧失功能，丧失独立性和害怕摔倒。我们知道某些药物， 包括那些影响中枢神经系统（CNS），增加老年人跌倒的风险， 以停用这些药物为目标的干预措施减少了福尔斯和与跌倒相关的伤害。我们也知道 通过福尔斯预防项目， 会很有挑战性老年人自己通常不会参与福尔斯预防行为，并且经常 报告称，来自医疗保健提供者的有限支持是参与福尔斯预防计划的障碍。 拟议研究的长期目标是为医疗保健系统制定一个可持续的计划， 减少在社区独立生活的高风险老年人的致命和非致命福尔斯跌倒。的 拟议的研究的目的是检查如何药物治疗计划，接地建立 可以在初级保健诊所实施药物取消处方和逐渐减少框架， 福尔斯在爱荷华州农村社区的老年人中，拟议的研究是一项 爱荷华州大学的研究人员和临床药剂师与来自 Mercy Health Network Accountable Care Organization（ACO）是一个非学术性的医疗保健系统。 深入到爱荷华州的农村社区利用与Mercy ACO的现有合作关系，我们 将使用有效性-实现混合设计来实现以下具体目标：（1）检查 基于诊所的个性化药物治疗计划在降低药物治疗率方面的有效性 农村地区老年人的福尔斯（次级目标1a）和机动车碰撞（次级目标1b） 初级保健诊所，（2）确定与患者依从性相关的提供者和患者因素， 药物处方和停药建议，以及（3）评价 药物治疗计划，以了解其可接受性，可用性和医疗保健系统之间的相关性 管理人员、诊所（诊所管理人员和临床工作人员）、提供者（健康教练、药剂师、开处方者） 和病人。实现这些目标将导致一个框架，如何个性化的药物治疗计划， 用于减少老年人经药物治疗后的福尔斯跌倒，可通过 医疗保健系统并由老年人实施。

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.