Medication Use, Comorbidity and Outcomes in Aging populations

描述(由申请人提供)：一个老年临床专家小组将药物管理中的问题列为改善脆弱老年人护理的最重要目标。65岁或65岁以上的人的特定年龄吸毒率最高，但大量证据表明，他们通常不会因各种疾病而接受适当的药物治疗。特别是，患有复杂慢性病的老年人接受无关疾病的预防性药物治疗的可能性似乎降低。这项应用旨在对老年人开始和持续使用预防性药物的决定因素进行大规模、纵向、观察性研究。特别关注的是常见的症状性疾病，包括抑郁症、帕金森病和慢性阻塞性肺病对预防性治疗的影响，包括青光眼药物、骨吸收药物和降脂药物。另一项评估将考虑生命最后一年的相对药物使用情况。其他方法学目标将量化处方中药物使用的分组，并评估对特定药物类别的新使用者进行研究的替代参考群体。研究将利用两大65岁或以上人群的行政索赔数据：1)1994年至2005年期间通过该州老年人药房援助合同(PACE)计划获得处方药保险的宾夕法尼亚州50,000多名老年居民；2)不列颠哥伦比亚省所有居民，包括1995-2005年期间通过该省的Pharmacare计划获得处方药福利的50多万人。这些人群的数据来源包括：所有处方的药物声明；住院和门诊数据，包括诊断；关于患者和他们的处方者的人口统计信息；以及关于计划资格和死亡率的信息。这些人口包括大量特别有可能得不到治疗的人，包括85岁及以上的人、妇女、黑人和患有多种疾病的人。数据分析将使用纵向和聚集数据的方法来解释在同一人中重复开药的情况，并描述开处方者中患者的聚集特征。这些研究旨在推进评估药物使用及其对老年人影响的方法学战略，并为干预措施改善这一人群的处方奠定基础。

DESCRIPTION (provided by applicant): A panel of geriatric clinical experts rated problems in pharmacologic management as the most important target for improvement of care in vulnerable older people. People aged 65 years or older have the highest age-specific drug consumption rates, yet abundant evidence indicates that they commonly do not receive appropriate drug treatment for a wide variety of conditions. In particular, older persons with complex chronic diseases appear to have a reduced likelihood of receiving preventive drug treatment for unrelated diseases. This application aims to conduct large-scale, longitudinal, observational studies of determinants of initiation and persistence of use of preventive drugs in older people. A particular focus is on the impact of common, symptomatic conditions, including depression, Parkinson disease, and chronic obstructive lung disease, on use of preventive therapies, including glaucoma drugs, bone resorption agents, and lipid-lowering drugs. Another evaluation will consider the relative use of drugs in the last year of life. Additional methodological aims will quantify the clustering of drug use within prescribers and evaluate alternative reference groups for studies of new users of specific medication classes. Studies will utilize administrative claims data from two large populations of persons aged 65 years or older: 1) over 500,000 older residents of Pennsylvania who had prescription drug coverage through that state's Pharmacy Assistance Contract for the Elderly (PACE) program between the years 1994 and 2005; and 2) all residents of British Columbia, including over 500,000 persons during the years 1995-2005, who received prescription benefits through that province's Pharmacare program. Data sources for these populations include: drug claims for all filled prescriptions; data on hospitalizations and outpatient visits including diagnoses; demographic information on patients and their prescribers; and information on program eligibility and mortality. These populations include large numbers of persons at particular risk for under-treatment including those aged 85 and above, women, blacks and those with multiple morbidities. Data analysis will use methods for longitudinal and clustered data to account for repeat prescriptions in the same people and to characterize the clustering of patients within prescribers. These studies are intended to advance methodologic strategies for evaluation of drug use and its effects in older people and to lay the foundation for interventions to improve prescribing in this population.