Improving the Quality of Medication Use in Older Adults

描述（由申请人提供）： 申请人的长期目标是成为一名独立的研究者，设计，实施和严格评估药物管理计划，以提高社区老年人的药物使用质量。老年人有发生药物相关问题的风险，这些问题：（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，努力将孤立的药物相关问题作为独立事件，忽视了这些事件在一个人身上的相互依赖性以及这些事件之间的重要相互作用。然而，考虑到老年人药物治疗方案的复杂性，以患者为中心的方法，解决存在于个体中的所有药物相关问题可能更有效。该计划将寻求临床药剂师作为团队成员参与，以提高老年人的药物使用质量。为此，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，以估计社区环境中长者所经历的药物治疗问题的普遍性和发生率，以及随着时间的推移未解决的问题的持续性。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，定性方法，使用从目标1中获得的信息开发的半结构化访谈，将用于从患者，医生和药剂师的角度识别优质药物使用的促进因素和障碍。在具体目标3中，具体目标1和2中进行的研究的结果将纳入药物管理计划的设计中，该计划将被实施和测试，以提高药物使用的质量。在此奖项结束时，将提交赠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公共卫生、药学、护理和医学等学校的丰富环境。本申请的主要共同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特别感兴趣，并增加临床药师作为医疗保健团队成员的作用;他们的互补背景将很好地为申请人服务。来自优秀顾问的承诺将进一步帮助申请人的研究和职业发展计划。职业发展计划已经精心制定，包括先进的定量分析，卫生政策和计划规划以及研讨会和指导，以培养申请人的研究技能的教学课程。

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.