Optimal Medication Management in Alzheimer's Disease and Dementia

项目总结： 绝大多数阿尔茨海默病和相关痴呆(ADRD)患者患有多种慢性 条件(MCC)。ADRD加其他疾病(ADRD-MCC)的组合导致更多的药物治疗 对患者来说，使用更复杂的用药方案，并与更大的不良药物风险相关 事件、药物相互作用、治疗负担和认知变化以及较高的住院率 和死亡率。通过取消处方来优化用药(减少或停止使用 不适当的药物或不太可能有益的药物)可以帮助避免药物不良反应和 改善MCC患者的预后，特别是ADRD患者。去处方药是一个新的领域 如果得到适当的发展和发展，很可能在未来十年产生重大的积极影响 实施。我们提出了一个项目，以完善和测试一种实用的停药干预措施，适用于患有 ADRD-MCC使这些患者接受“恰到好处”的药物治疗。我们这个项目的总体目标是 完善和测试以患者和家庭/护理人员为中心的停药干预措施，该干预措施适用于 可用于药物治疗，并可适用于各种医疗保健提供环境。 这项干预将针对服用5种或更多药物的ADRD-MCC老年患者及其家庭照顾者 并在科罗拉多州凯撒永久(Kaiser Permanente Colorado)提供干预，这是一个非营利性的综合交付系统。 目标1和目标2将侧重于让患者、家庭/照顾者、临床医生和卫生系统利益攸关方参与 加强、完善和试行干预措施。目标3和目标4将测试干预措施的有效性 减少慢性药物的数量和潜在的适当药物的数量 患者跌倒的次要结果、药物不良事件、医院和熟练护理设施的使用情况， 日常生活活动、门诊就诊时间长短。目标5将定性地探索背后的机制 干预效果。 拟议的项目将展示在药物方面实施可持续变化的潜力。 提高ADRD合并症治疗患者健康安全的管理 服用多种药物的情况。它将适用于其他交付系统和设置，并 旨在培养ADRD-MCC患者可以接受的深思熟虑的药物决策文化， 护理者和他们的临床医生。

PROJECT SUMMARY: The vast majority of individuals with Alzheimer's disease and related dementias (ADRD) have multiple chronic conditions (MCC). The combination of ADRD plus other conditions (ADRD-MCC) leads to more medication use, more complex medication regimens for patients, and is associated with greater risk of adverse drug events, drug interactions, treatment burden and cognitive changes in addition to higher rates of hospitalization and mortality. Optimizing medication through deprescribing (the process of reducing or stopping the use of inappropriate medications or medications unlikely to be beneficial) can help avoid adverse drug effects and improve outcomes for MCC patients, particularly for those with ADRD. Deprescribing is a nascent field in the U.S. that is likely to have a significant positive impact over the next decade if properly developed and implemented. We propose a project to refine and test a pragmatic deprescribing intervention for people with ADRD-MCC so that these patients are on “just right” medication regimens. Our overall goal for the project is to refine and test a patient- and family/caregiver- centric deprescribing intervention that is applicable to multiple medications and can be adapted to a variety of healthcare delivery settings. The intervention will target older adults with ADRD-MCC on 5 or more medications and their family caregivers and deliver the intervention at Kaiser Permanente Colorado (KPCO), a not-for-profit integrated delivery system. Aims 1 and 2 will focus on engaging patients, family/ caregivers, clinicians and health system stakeholders to enhance, refine, and pilot test the intervention. Aims 3 and 4 will test the effectiveness of the intervention in reducing number of chronic medications and number of potentially in appropriate medications as well secondary outcomes of patient falls, adverse drug events, hospital and skilled nursing facility utilization, activities of daily living, and outpatient office visit length. Aim 5 will qualitatively explore mechanisms behind intervention effectiveness. The proposed project will demonstrate the potential to implement sustainable changes in medication management to improve the health and safety of patients with ADRD receiving treatment for comorbid conditions with multiple medications. It will be adaptable to other delivery systems and settings, and is designed to foster a culture of thoughtful medication decision-making acceptable to ADRD-MCC patients, caregivers, and their clinicians.