Effect of Medication Management at Home via Pharmacy Home Televisits

老年人更有可能患有多种慢性病，需要多次开出处方 药物，而且更容易受到药物不良反应的影响。此外，年龄较大的 成年人经常使用非处方药和补充剂，使他们的病情进一步复杂化 药物治疗方案。复杂的药物治疗方案对老年人有潜在的伤害，因为 潜在的药物相互作用，潜在的不适当处方或非处方药使用， 以及药物不遵守可能导致慢性病控制不佳。干预措施 旨在减少门诊环境中的用药差异，例如审查 书面用药清单，并实施“棕色袋子”对账(要求患者 将所有药瓶带到诊所进行审查)继续具有挑战性，并具有 有限的成功。临床药剂师领导的干预措施，以改善适当的药物使用 老年人，包括启动/停止标准的应用，已经证明 减少药物不良事件的有效性。随着VA远程医疗能力的增强 到退伍军人家中，通过临床远程访问提供药物管理 药剂师有可能为更多的老年退伍军人带来类似的好处。 远程医疗在VHA内是一个日益重要的组成部分，以增加访问和改善 护理质量。通过将护理扩展到实体诊所之外，远程医疗增加了 护理团队的覆盖范围更广，更方便患者，从而改善患者状况 满足感。利用远程医疗到达患者家中的能力，我们建议 通过家庭视频电视检查临床药师用药管理的效果， 因为家庭视频访问有可能为老年人提供直接的药物可视化 成年人的家庭，从而减少用药差异和增加用药依从性。 药剂师对老年人用药方案的管理也可能改善适当的 通过直接药剂师-患者访谈和教育在老年人中使用药物。在……里面 支持这一申请，我们的调查团队的初步数据表明 老年人对视频电视的可接受性，患者和退伍军人管理局对视频电视的接受度较高 供应商，而且视频电视进入家庭是可行的。 在这项研究中，我们的目标是开发一种用于药房家庭电视用药的协议 对患有多种慢性病和患有多种疾病的老年人的管理 药物。然后，我们将进行一项采用混合有效性类型I设计的随机试验，以 检查这些电视节目对适当用药、用药差异、 遵守情况和药物不良事件，并观察和收集有关执行情况的信息。 我们预计，药剂师领导的药物管理家庭远程访问干预将导致 减少潜在的不适当用药，减少用药 老年人的差异、更高的服药依从性和减少的不良药物事件 成年人与接受通常护理的老年人相比。我们还将检查障碍和 促进实施干预措施，以便研究结果可为未来提供信息 实施。

Older adults are more likely to suffer from multiple chronic conditions, to be prescribed multiple medications, and are more susceptible to adverse effects of medications. In addition, older adults often use over-the-counter medications and supplements, further complicating their medication regimen. Complex medication regimens are potentially harmful to older adults due to potential drug interactions, potentially inappropriate prescribing or over-the-counter drug use, and medication non-adherence that may lead to poor control of chronic disease. Interventions aimed at reducing medication discrepancy in the ambulatory clinic setting, such as the review of written medication lists, and implementation of “brown bag” reconciliation (asking patients to bring in all medication bottles for review in the clinic) continues to be challenging and have limited success. Clinical pharmacist led interventions to improve appropriate medication use in older adults, including the application of the START/STOPP criteria, have demonstrated effectiveness in reducing adverse drug events. With the increased capability of VA telemedicine to reach Veteran in their homes, delivering medication management via televisit by clinical pharmacists has the potential to yield similar benefits for a larger number of older Veterans. Telemedicine is an increasingly vital component within VHA to increase access and improve quality of care. By extending care beyond brick-and-mortar clinics, telemedicine increases the reach of care teams and is more convenient for patients, resulting in improved patient satisfaction. Using the capability of telemedicine to reach patients' homes, we propose to examine the effect of medication management by clinical pharmacists via home video televisits, as home video visits have the potential to provide direct visualization of medications in older adults' homes, thereby reducing medication discrepancy and increasing medication adherence. Pharmacist management for older adult medication regimen may also improve appropriate medication use in older adults through direct pharmacist-patient interview and education. In support of this application, preliminary data from our team of investigators demonstrate acceptability of video televisits by older adults, that there is good uptake by patients and VA providers, and that video televisits into the home are feasible. In this study, we aim to develop a protocol for pharmacy home televisits for medication management in older adults who have multiple chronic conditions and are on multiple medications. We will then conduct a randomized trial with hybrid effectiveness Type I design to examine the effect of these televisits on appropriate medication use, medication discrepancies, adherence and adverse drug events and observe and gather information on implementation. We anticipate that a pharmacist led medication management home televisit intervention will lead to reduction in potentially inappropriate use of medication, reduction in medication discrepancies, increased medication adherence and reduced adverse drug events in older adults compared to older adults receiving usual care. We will also examine the barriers and facilitators in implementing the intervention so that the study findings may inform future implementation.