Implementation of a De-prescribing Medication Protocol to Evaluate Falls in Older Adults

摘要 这项拟议的研究将聘请卫生保健专业人员(HCP)对老年患者进行筛查 有摔倒的危险。我们将使用阻止老年人事故、死亡和伤害(STEADI)工具包 因此，所有的初级保健计划都可以确定有可能落入初级保健门诊的患者。 北卡罗来纳大学医疗保健系统。这些患者将使用电子健康记录进行识别 (EHR)来自北卡罗来纳大学医疗保健。65岁或以上并服用其中一种药物的患者 阿片类药物或苯二氮类药物(BZD)将被纳入研究。这些诊所将与 确定有跌倒风险的患者，教育患者跌倒的风险和他们的 阿片类药物或BZD药物(S)，并实施取消处方用药方案 多学科团队。先前的研究表明，阿片类药物和苯二氮卓类药物 这是最难管理、最不可能导致变化的问题之一。鉴于这个国家的 在当前的阿片类药物危机中，我们的新方法将侧重于教育HCP如何使用脱毒药物 这些药物在有跌倒风险的老年人中的处方方案，包括替代方案 (和多学科)治疗方式和/或必要的药物治疗。这项建议 这项研究将使用共享的EHR来记录Steadi筛查问题的答案。我们打算 创建特定于瀑布教育的方案以及有关特定停药的信息 BZD和阿片类药物，包括治疗疼痛、失眠和/或焦虑的替代策略。 通过使用电子健康记录，我们将能够为跌倒预防服务提供转介 对有高血压风险的老年人使用阿片类药物和BZD药物的停药方案 瀑布。我们将能够结合替代(和多学科)治疗方式和/或 在必要的情况下服用药物。这项研究将确定影响有效性的因素， 采用、实施和维护以BZD和BZD为重点的非处方计划 阿片类药物，目的是减少跌倒。这将使我们能够为开发 并在美国各地的其他医疗系统实施类似的计划。

Abstract The proposed study will engage health care professionals (HCPs) to screen older adult patients at risk for falls. We will use the Stopping Elderly Accidents, Deaths and Injuries (STEADI) toolkit so all HCPs can identify patients at risk for falling within outpatient primary care clinics within the UNC Health Care System. These patients will be identified using an electronic health record (EHR) from UNC Health Care. Patients who are 65 years of age or older and taking either one opioid or benzodiazepine (BZD) will be included in the study. These clinics will engage the identified patients at risk for falls, educate patients on the risk of falls and injury posed by their opioid or BZD medication(s), and implement a de-prescribing medication protocol with a multidisciplinary team. Prior research indicates that opioid and benzodiazepine medications are among the most difficult to manage and least likely to result in a change. Given the country's current opioid crisis, our new approach will focus on educating HCPs on how to employ a de- prescribing protocol for these medications in older adults at risk for falls, incorporating alternate (and multidisciplinary) treatment modalities and/or medications where warranted. This proposed study will use a shared EHR to document answers to STEADI screening questions. We intend to create protocols specific to falls education as well as information about de-prescribing specific to BZDs and opioids, including alternate strategies for managing pain, insomnia, and/or anxiety. By using the EHR, we will be able to provide referral for fall prevention services beyond employing a de-prescribing protocol for opioid and BZD medications in older adults at risk for falls. We will be able to incorporate alternate (and multidisciplinary) treatment modalities and/or medications where warranted. This study will identify factors affecting the effectiveness, adoption, implementation, and maintenance of a de-prescribing program focused on BZDs and opioids with the intent of reducing falls. This will enable us to create guidelines for developing and implementing similar programs for other health systems across the United States.