University of Iowa Older Adults CERT

描述(由申请人提供)：14%至23%的老年人接受了他们不应该开出的药物。高达40%的患者没有按处方服药。某些药物的使用不足，如β受体阻滞剂或血管紧张素转换酶抑制剂，也令人担忧。虽然临床实践指南已经存在，对于特定疾病，偏离最佳实践的情况也有很好的记录，但尚不清楚这些指南是否适用于患有多种合并症的老年人。在临床试验证明对老年人有治疗益处的有限临床情况下，遵守指南的障碍在老年人中更为普遍，包括药物对药物的相互作用、药物-疾病禁忌症、决策能力的改变，以及由于多种药物治疗而产生的复合不良事件风险。爱荷华大学老年人CERTs(UIOAC)为CERTs项目提供研究专业知识，用于(1)对由功能状态、合并症和年龄等重要特征定义的老年人亚群的治疗效果和成本效益进行政策性评估，以及(2)确定和设计干预措施，以解决社区护理环境中老年人获得最佳治疗的障碍。我们的合作精神体现在我们与社区医生和药剂师研究网络的项目以及与州和联邦资助机构以及包括健康计划和全国连锁药房组织在内的最终用户的合作中。 UIOAC的具体目标是： 1.通过以下方式提高老年人用药的安全性和有效性 A.将高血压管理的协作模式转化为老年患者社区护理的准实验性干预研究。 B.三项数据库研究和一项前瞻性研究，研究化疗中的年龄差异、功能状态、存活率和成本效益结果。 C.对《医疗保险处方药、改进和现代化法案》(MMA)对患者用药安全性和可及性的影响进行纵向调查。 三项关于患者决策的年龄相关变化及其对健康结果的影响的研究。 2.通过以下方式将现有合作扩大到与私营和公共实体的新伙伴关系 A.一个发展项目，旨在制定一种系统的程序，以确定和解决社区中的老年用药问题，目的是在不同的公共和私人诊所环境中执行这一程序。 3.教育提供者、患者和政策制定者有关老年人的治疗决策。

DESCRIPTION (Provided by the Applicant): Between 14 and 23% of the elderly receive a medication they should not have been prescribed. Up to 40% of patients do not take their medications as prescribed. Under-use of certain medications like beta blockers or ACE inhibitors is also of concern. Whereas clinical practice guidelines exist and departures from optimal practice are well-documented for specific diseases, it is not known whether such guidelines generalize to the elderly with multiple co-morbidities. In the limited clinical situations where clinical trial evidence of therapeutic benefit among the elderly is strong, barriers to guideline adherence are more prevalent in the elderly including drug-to-drug interactions, drug-disease contraindications, alterations in decision-making capacities, and compounded adverse event risk due to multiple medications. The University of Iowa Older Adults CERTs (UIOAC) offers the CERTs program research expertise for (1) making policy-relevant estimates of treatment effects and cost-effectiveness among subsets of the elderly defined by important characteristics such as function status, co-morbidity, and age and (2) identifying and designing interventions to address barriers to optimal therapeutics in the elderly in community care settings. Our collaborative spirit is indicated by our projects with community-based physician and pharmacist research networks and collaborations with state and federal funding agencies as well as end-users including health plans and a national chain pharmacy organization. The specific aims of the UIOAC are to: 1. Improve safety and effectiveness of medication use among older adults by a. A quasi-experimental intervention study of translating a collaborative model of hypertension management into community care of elderly patients. b. Three database studies and one prospective study of age disparities in chemotherapy treatments and function status, survival, and cost-effectiveness outcomes. c. A longitudinal survey of the effect of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) on patient medication safety and access. d. Three studies of age-related changes in patient decision making and their effect on health outcome. 2. Expand existing collaborations to new partnerships with private and public entities by a. A developmental project to formulate a structured procedure for identifying and resolving geriatric medication problems in the community with the goal of implementing the procedure in diverse public and private practice settings. 3. Educate providers, patients, and policy makers about therapeutic decision-making in the elderly.