Improving Over-the-Counter Medication Safety for Older Adults

 描述（由申请人提供）：与非处方（OTC）药物相关的药物不良事件（ADE）每年导致178，000例住院，这是一个主要的患者安全问题。65岁以上的老年人是AHRQ的重点人群之一，特别容易受到ADE的影响。在220万被认为有重大ADE风险的老年人中，超过50%是因为同时使用OTC和处方药。然而，没有有效的干预措施试图减少与OTC药物使用相关的伤害。我们建议实施和评估系统重新设计干预措施，以减少高风险的OTC药物滥用。这种干预措施将通过以下特点改善老年人和社区药剂师之间的沟通来减少滥用：重新设计商店的物理环境，使老年人对高风险的OTC药物敏感，并实施临床决策工具，以支持药剂师在严格评估老年人的健康状况时。我们的假设是， 通过与社区药剂师交谈，他们更了解风险，并且可以更容易地确定该风险是否与他们自己的健康状况有关，这将使他们在选择OTC时更加了解，这反过来又会导致更安全的OTC使用。我们的具体目标是：1）完善制度 通过诊断性和形成性评价，评估重新设计干预措施和实施策略，2）评估精细化系统重新设计干预措施在预防老年人滥用高风险OTC药物方面的有效性，3）评估社区药房精细化系统重新设计干预措施的实施情况。本研究将在三家大型商品店进行，并在店内设有药房。我们将通过征求老年人和药房利益相关者的反馈，以及在一家商店小规模实施系统重新设计来完善干预措施（目标1）。接下来，我们将使用前/后设计来测试系统重新设计干预措施，并评估其在两个药店中的实施情况（目标2和3）。观察、调查和访谈将用于评估干预措施的有效性和实施策略。 这项研究具有重要意义和创新性，原因有几个：我们经验丰富的多学科团队包括来自药学，护理，公共卫生，工程和医学的成员;我们将使用人因工程理论和方法来设计和实施以患者为中心的干预措施;我们正在与社区药房合作，致力于改善社区的健康，健康和自我护理。

 DESCRIPTION (provided by applicant): Adverse drug events (ADEs) associated with over-the-counter (OTC) medications cause 178,000 hospitalizations each year, representing a major patient safety concern. Older adults, aged 65+, one of AHRQ's priority populations, are particularly vulnerable to ADEs. Of the 2.2 million older adults considered at risk of a major ADE, more than 50% were because of concurrent use of an OTC and prescription medication. However, no effective interventions have attempted to decrease harm associated with OTC medication use in this population. We propose to implement and evaluate a system redesign intervention to decrease high-risk OTC medication misuse. This intervention will reduce misuse by improving communication between older adults and community pharmacists via the following features: a redesign of the store's physical environment to sensitize older adults to high-risk OTC medications, and the implementation of a clinical decision tool to support the pharmacist when critically evaluating the older adult's health status. Our hypothesis is that older adults who are more aware of risks and can more easily determine if that risk pertains to their own health situation by speaking with a community pharmacist will be more knowledgeable in their OTC selection, which will in turn lead to safer OTC use. Our specific aims are: 1) to refine the system redesign intervention and implementation strategy through diagnostic and formative evaluation, 2) to evaluate the effectiveness of a refined system redesign intervention on preventing misuse of high-risk OTC medications by older adults, and 3) to evaluate the implementation of a refined system redesign intervention in community pharmacies. The study will be conducted in three mass-merchandise stores with onsite pharmacies. We will refine the intervention (Aim 1) by eliciting feedback from older adult and pharmacy stakeholders, and by implementing the system redesign on a small scale in one store. Next, we will use a pre/post design to test the system redesign intervention and evaluate its implementation in two pharmacies (Aims 2 and 3). Observations, surveys, and interviews will be used to assess the intervention effectiveness and the implementation strategy. This study is significant and innovative for several reasons: our highly experienced and multidisciplinary team includes members from pharmacy, nursing, public health, engineering, and medicine; we will use human factors engineering theories and methods to design and implement a patient-centered intervention; and we are partnering with a community pharmacy committed to improving health, wellness, and self-care in its communities.