Guideline Adherence in Elders With Multiple Comorbidities

描述（由申请人提供）：依据：药物不良反应（ADR）在非卧床老年人中很常见，通常很严重。然而，人们对诸如虚弱等经典的老年特征如何影响ADR风险知之甚少，并且几乎没有临床有用的工具来量化个体老年人的ADR风险。 研究目的/宗旨：我们的目的是（1）确定老年人药物不良反应的风险因素，特别关注老年人的特征，包括身体，认知和社会脆弱性;（2）开发和验证预测工具，以评估老年人的ADR风险;（3）使用临床医生焦点小组和访谈，以完善和试点测试基于ADR风险预测指数的干预措施。在Beeson奖期结束时，我们将提交R 01资助提案来测试这种干预措施。 方法：我们将收集和跟踪一个前瞻性队列的400名老年人出院后，从两家弗朗西斯科医院。通过一系列电话访谈和图表审查，我们将使用经验证的方法来识别和描述药物不良反应，并收集各种潜在风险因素的信息。对于目标（3），我们将进行焦点小组和结构化认知访谈，以完善并初步测试基于ADR风险指数的干预措施。 分析：对于目标1，我们将使用混合努力泊松回归来确定ADR的风险因素。对于目标2，我们将使用标准技术开发和验证ADR的风险预测指数。对于目标3，我们将使用定性技术来分析焦点小组和访谈记录的相关内容。 与公共卫生的相关性：量化老年人的ADR风险可以帮助临床医生权衡药物治疗的利弊，并针对高风险老年人进行基于系统的干预，以减少ADR并改善处方，从而改善临床护理。拟议的研究将获得数据，以支持未来的干预研究，其目标是减少药物不良反应和改善老年人的处方。

DESCRIPTION (provided by applicant): Rationale: Adverse drug reactions (ADRs) are common and often severe in ambulatory elders. However, little is known about how classically "geriatric1 features such as frailty impact ADR risk, and few clinically- useful tools exist to quantify the risk of ADRs in individual older persons. Research objectives / aims: Our aims are (1) to determine risk factors for adverse drug reactions in elders, with a particular focus on geriatric features including physical, cognitive, and social vulnerability; (2) to develop and validate a prediction tool to assess ADR risk in elders; and (3) to use clinician focus groups and interviews to refine and pilot test an intervention based on the ADR risk prediction index. At the conclusion of the Beeson Award period, we will submit a R01 grant proposal to test this intervention. Methods: We will assemble and follow a prospective cohort of 400 elders following discharge from two San Francisco hospitals. Through serial telephone interviews and chart review, we will use validated methods to identify and characterize adverse drug reactions and to collect information on a variety of potential risk factors. For Aim (3), we will conduct focus groups and structured cognitive interviews to refine and then pilot test an intervention based on the ADR risk index. Analyses: For Aim 1, we will use mixed-efforts Poisson regression to determine risk factors for ADRs. For Aim 2, we will use standard techniques to develop and validate a risk prediction index for ADRs. For Aim 3, we will use qualitative techniques to analyze focus group and interview transcripts for relevant content. Relevance to public health: Quantifying ADR risk in elders can improve clinical care by helping clinicians weigh the benefits vs. harms of drug therapy and by targeting high-risk elders for systems-based interventions to reduce ADRs and improve prescribing. The proposed research will obtain data to support a future intervention study whose goal is to reduce ADRs and improve prescribing for elders.