Improving Safety after Hospitalization in Older Persons on High Risk Medications

 描述（由申请人提供）：国家药物不良事件（ADE）预防行动计划确定了三种高优先级药物类别作为降低药物相关损伤风险的关键目标：抗凝剂;糖尿病药物（胰岛素和口服药物）;阿片类药物。之所以选择这些药物类别，是因为它们对患者造成的可测量药物相关伤害最多，并且与这些药物相关的ADE中有很大一部分被认为是可以预防的。拟议项目的总体目标是进行一项大型临床试验，重点关注最近出院的老年患者，他们服用了抗凝剂、糖尿病药物或阿片类药物。临床试验将确定多方面用药错误和ADE减少干预的价值，特别关注家庭评估。干预措施的组成部分将包括：（1）由临床药剂师对高风险患者进行家庭评估;（2）针对高风险患者及其护理人员的最佳实践、循证药物安全工具和资源;（3）通过电子健康记录与初级保健团队就与使用高风险药物有关的问题以及其他药物安全问题进行沟通;以及（4）药剂师在家庭访视的14天内对患者和/或护理者的随访电话。关注的主要结局将是具有临床意义的用药错误，复合结局包括可预防或可改善的ADE以及由于用药差异或不依从导致的潜在ADE。次要结局将包括：（1）可预防或可改善的ADE;（2）由于不一致或不依从导致的潜在ADE;和（3）判定为严重、危及生命或致命的可预防或可改善的ADE。从这次审判中获得的知识是大量的。如PA-14-002所述（通过安全用药研究推进患者安全实施），“减少药物不良事件（ADE）是卫生与公众服务部（DHHS）的首要任务，目前正在制定一项综合战略，以显著减少占所有ADE很大比例的三类ADE：抗凝血剂、糖尿病药物和阿片类药物。“这项研究提案与DHHS的优先事项以及AHRQ的患者安全组合保持一致，该组合致力于开发，实施和采用以及广泛传播改善健康结果的工具和资源。拟议研究的最终目标是通过证明有效的干预策略来降低高风险老年患者（AHRQ优先人群）中与ADE相关的公共卫生负担。

 DESCRIPTION (provided by applicant): The National Action Plan for Adverse Drug Event (ADE) Prevention identified three high-priority drug classes as key targets for reducing the risk of drug-related injuries: anticoagulants; diabetes agents (insulin and oral agents); and opioids. These medication classes were chosen because they account for the greatest number of measurable drug-related harms to patients, and a substantial proportion of ADEs associated with these medications is considered preventable. The overarching objective of the proposed project is to pursue a large clinical trial focused on older patients recently discharged from the hospital who have been prescribed anticoagulants, diabetes agents, or opioids. The clinical trial will determine the value of a multifaceted medication error and ADE reduction intervention with a special focus on in-home assessment. Components of the intervention will include: (1) in-home assessment of high-risk patients by a clinical pharmacist; (2) best- practice, evidence-based medication safety tools and resources targeted to high-risk patients and their caregivers; (3) communication with the primary care team via the electronic health record regarding concerns relevant to the use of high-risk medications as well as other medication safety concerns; and (4) a follow-up phone call by the pharmacist to the patient and/or caregiver within 14 days of the home visit. The primary outcome of interest will be clinically important medication errors, a composite outcome comprised of preventable or ameliorable ADEs and potential ADEs due to medication discrepancies or non-adherence. Secondary outcomes will include: (1) preventable or ameliorable ADEs; (2) potential ADEs due to discrepancies or non-adherence; and (3) preventable or ameliorable ADEs judged to be serious, life- threatening, or fatal. The knowledge to be gained from this trial is substantial. As stated in PA-14-002 (Advancing Patient Safety Implementation through Safe Medication Use Research), "Reduction of adverse drug events (ADEs) is a top priority for the Department of Health and Human Services (DHHS), and a comprehensive strategy is in development in order to significantly reduce ADEs within the three classes which account for a significant proportion of all ADEs: anticoagulants, diabetes agents, and opioids." This research proposal aligns with this DHHS priority and with the Patient Safety Portfolio at AHRQ which is committed to the development, implementation and adoption, and wide-spread dissemination of tools and resources to improve health outcomes. The ultimate goal of the proposed research is to mitigate the public health burden related to ADEs among high-risk elderly patients (an AHRQ priority population) by demonstrating an effective intervention strategy to reduce this risk.