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、实施并严格评估药物管理计划，以提高社区环境中老年人药物使用的质量。老年人面临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；(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，忽视了这些事件在人体内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，一个以病人为中心的解决所有与药物相关的问题的方法可能更有效。开发的项目将寻求临床药剂师作为团队成员，以提高老年人用药的质量。为此，提出了三个具体目标。在Specific Aim 1中，将进行为期1年的队列研究，以估计社区环境中老年人经历的药物治疗问题的患病率和发生率，以及未解决问题随时间的持续存在。目的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确定高质量药物使用的促进因素和障碍。在具体目标3中，在具体目标1和2中进行的研究结果将被纳入药物管理计划的设计，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，将提交一份拨款申请，进行随机试验，以严格评估最终项目。

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.