Transforming the Medication Regimen Review Process of High-Risk Drugs Using a Patient-Centered Telemedicine-Based Approach to Prevent Adverse Drug Events in the Nursing Home

使用以患者为中心的远程医疗方法转变高风险药物的用药方案审查流程，以预防疗养院中的药物不良事件

• 批准号: 9132177
• 负责人: Sandra L Kane-Gill
• 金额: $ 49.69万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-01 至 2018-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9132177
• 关键词: Transforming; Medication; Regimen; Review; Process

 DESCRIPTION (provided by applicant): In response to PA-14-002, we are proposing to conduct a cluster-RCT for a period of a year, to determine the impact of patient-centered telemedicine-based high-risk medication regimen reviews on adverse drug event (ADE) reduction in four nursing homes (NH). The National Action Plan for Adverse Drug Event Prevention identified, the nearly 16,000 NHs, as a clinical setting where adverse drug event (ADE) prevention strategies are lacking for high-risk drug classes including anticoagulants, antidiabetic agents, and opioids. The Office of Inspector General Report estimates that 37% of all harmful adverse events are related to drugs and two-thirds are preventable. A variety of approaches have been taken to minimize the occurrence of ADEs. Federal regulations require that residents' drug regimen should be free from unnecessary drugs (F-Tag 329) and a consultant pharmacist conduct a Medication Regimen Review (MRR) on each resident at least monthly (F-Tag 428). More frequent MRRs are required for residents with additional risk factors, such as receiving high-risk drug classes that place them at a higher chance of developing ADEs. Current ADE prevention strategies are failing to improve medication safety in NH residents because: 1) MRRs are almost always conducted retrospectively; 2) consultant pharmacists are usually not involved in MRR on admission to the NH, and 3) the MRR process is not patient-centered. We propose to address these medication safety gaps by first prospectively identifying NH residents who are either newly admitted with, or subsequently prescribed, a high- risk drug during their NH stay. We will introduce the use of telemedicine to improve timely access to consultant pharmacists who can provide patient-centered MRRs when a high-risk drug is prescribed. Telemedicine will also be used by the consultant pharmacist to directly interact with the resident and engage him/her in education to recognize and prevent ADEs associated with high-risk drugs. Telemedicine has been successfully employed by NHs, but its use is limited to a finite number of patient care issues and has not used for medication safety. In this study, we will evaluate the effect of pharmacist-led MRRs using patient-centered telemedicine for residents receiving high-risk drugs commonly associated with ADEs. We will also evaluate the residents' satisfaction and healthcare professionals' perception of pharmacist performance with this enhanced consultant pharmacist service. This study will correct a faulty retrospective 30-day MRR and provide a model for more frequent MRR when residents are prescribed a high-risk drug during their stay to prevent ADE occurrence with the innovative use of patient-centered telemedicine technology. The product of this research will be a generalizable electronic medical record-agnostic MRR model including decision support rules, and structured communication tools to optimally execute the consultant pharmacist's role in ADE prevention in the NH.

 描述（由申请人提供）：作为对PA-14-002的回应，我们建议进行为期一年的集群RCT，以确定以患者为中心的基于远程医疗的高风险药物治疗方案审查对四家疗养院（NH）药物不良事件（ADE）减少的影响。国家药物不良事件预防行动计划确定了近16，000个国家卫生机构，作为缺乏高风险药物类别（包括抗凝剂，降糖药和阿片类药物）药物不良事件（ADE）预防策略的临床环境。监察长办公室的报告估计，37%的有害不良事件与药物有关，三分之二是可以预防的。已采取各种方法尽量减少ADE的发生。联邦法规要求住院医师的药物方案不应使用不必要的药物（F-Tag 329），顾问药剂师至少每月对每位住院医师进行一次药物方案审查（MRR）（F-Tag 428）。对于有其他风险因素的居民，需要更频繁的MRR，例如接受高风险药物类别，使他们更有可能发生ADE。目前的ADE预防策略未能改善NH居民的用药安全性，因为：1）MRR几乎总是回顾性进行的; 2）顾问药剂师通常不参与NH入院时的MRR，3）MRR过程不是以患者为中心的。我们建议通过首先前瞻性地确定NH居民谁是新入院的，或随后规定，高风险药物在他们的NH逗留期间，解决这些药物安全的差距。我们将引入远程医疗的使用，以提高及时获得顾问药剂师谁可以提供以病人为中心的MRR时，高风险的药物处方。顾问药剂师还将使用远程医疗与住院医师直接互动，并让他/她参与教育，以识别和预防与高风险药物相关的ADE。远程医疗已经成功地被NHS采用，但其使用仅限于有限数量的患者护理问题，并且尚未用于药物安全。在这项研究中，我们将评估药剂师领导的MRR的效果，使用以患者为中心的远程医疗的居民接受高风险药物通常与ADE。我们还将通过这项增强的顾问药剂师服务评估居民的满意度和医疗保健专业人员对药剂师表现的看法。这项研究将纠正错误的回顾性30天MRR，并提供一个模型，当居民在住院期间被处方高风险药物时，更频繁的MRR，以防止ADE的发生，并创新地使用以患者为中心的远程医疗技术。本研究的产品将是一个可推广的电子医疗记录不可知的MRR模型，包括决策支持规则和结构化的沟通工具，以最佳地执行顾问药剂师在NH的ADE预防中的作用。