Improving the Quality of Medication Use in Older Adults

描述(由申请者提供)：申请者的长期目标是成为一名独立的调查者，设计、实施和严格评估药物管理计划，以提高社区老年人的用药质量。老年人有发生与药物有关的问题的风险：(1)增加发病率、卫生服务利用率和死亡率；(2)损害健康状况和生活质量。传统上，努力将与药物有关的孤立问题作为独立事件来处理，忽视了这些事件在人身上的相互依存关系以及这些事件之间的重要相互作用。然而，考虑到老年人用药方案的复杂性，以患者为中心的方法解决个人存在的所有与药物有关的问题可能会更有效。制定的计划将寻求让临床药剂师作为团队成员，以提高老年人的用药质量。为了实现这一目标，提出了三个具体目标。在具体目标1中，将进行一项为期一年的队列研究，以评估老年人在社区环境中经历的药物治疗问题的发生率和发生率，以及长期未解决的问题的持续时间。目标1还将研究种族与药物治疗问题的数量和类型的关系。在具体目标2中，将使用根据目标1中获得的信息开发的半结构化访谈的定性方法，从患者、医生和药剂师的角度确定高质量药物使用的促进者和障碍。在具体目标3中，将把在具体目标1和2中进行的研究的结果纳入药物管理方案的设计，该方案将被实施和测试，以提高药物使用的质量。在本奖项结束时，将提交一份拨款申请，进行随机试验，以严格评估最终计划。 拟议的职业发展计划利用了北卡罗来纳大学公共卫生、药学、护理和医学院的丰富环境。这项申请的主要合作导师是经验丰富的研究人员和导师，他们对高质量的药物使用和增加临床药剂师作为医疗保健团队成员的作用特别感兴趣；他们的互补背景将很好地服务于申请者。杰出顾问的承诺将进一步帮助申请者制定研究和职业发展计划。职业发展计划经过精心制定，包括高级定量分析、卫生政策和项目规划方面的授课课程，以及培养申请者研究技能的研讨会和指导。

DESCRIPTION (provided by applicant): The long-term goal of the applicant is to become an independent investigator who designs, implements, and rigorously evaluates a medication management program to improve the quality of medication use for older adults in the community setting. Older adults are at risk of developing medication-related problems that: (1) increase morbidity, health services utilization, and death and (2) compromise health status and quality of life. Traditionally, efforts target isolated medication-related problems as independent events, overlooking the interdependency of such events in a person as well as important interactions among these events. However, given the complexity of older adults' medication regimens, a patient-centered approach that addresses all medication-related problems that are present in an individual may be more effective. The program developed will seek to involve clinical pharmacists as team members to improve the quality of medication use for older adults. To accomplish this, three specific aims are proposed. In Specific Aim 1, a 1-year cohort study will be conducted to estimate the prevalence and incidence of drug therapy problems experienced by elders in the community setting as well as the persistence of unresolved problems over time. Aim 1 will also examine the relationship of race to the number and type of drug therapy problems. In Specific Aim 2, qualitative methodologies, using semi-structured interviews developed from information obtained in Aim 1, will be used to identify facilitators of, and barriers to, quality medication use from the perspectives of patients, physicians, and pharmacists. In Specific Aim 3, results from studies conducted in Specific Aims 1 and 2 will be incorporated into the design of a medication management program that will be implemented and tested to improve the quality of medication use. By the conclusion of this award, a grant application will be submitted to conduct a randomized trial to rigorously evaluate the final program. The proposed career development plan capitalizes on the rich environment at the UNC Schools of Public Health, Pharmacy, Nursing, and Medicine. The primary co-mentors on this application are experienced researchers and mentors with a particular interest in quality medication use and increasing clinical pharmacists' roles as members of health care teams; their complementary backgrounds will serve the applicant well. Commitments from outstanding advisors will further assist the applicant in the research and career development plans. The career development plan has been carefully developed to include didactic courses in advanced quantitative analysis, health policy, and program planning as well as seminars and mentoring to foster the research skills of the applicant.