Implementation of a Medication Care Plan to Reduce Unintentional Injury among Rural Older Adults

项目摘要 在美国，跌倒是老年人意外致死和非致命伤害的主要原因。在……里面 在爱荷华州，老年人与跌倒相关的死亡率和住院率高于全国平均水平。 在美国，每年超过三分之一的老年人摔倒，其中许多摔倒会导致受伤，人数减少 或者永久丧失功能、丧失独立性和对摔倒的恐惧。我们知道某些药物， 包括那些影响中枢神经系统(CNS)的疾病，增加老年人跌倒的风险，以及 针对停用这些药物的干预措施减少了跌倒和跌倒相关的伤害。我们也知道 通过预防跌倒计划，覆盖高危老年人，包括那些生活在农村社区的老年人 可能会很有挑战性。老年人自己通常不会从事预防跌倒的行为，而且经常 报告称，来自医疗保健提供者的有限支持是参与跌倒预防计划的障碍。 拟议研究的长期目标是为医疗保健系统制定一个可持续的计划，以 减少在社区中独立生活的高危老年人的致命和非致命跌倒。这个 这项拟议研究的目标是检查如何建立一个基于 取消药物处方和缩减框架，可以在初级保健诊所实施，以减少 居住在爱荷华州农村社区的老年人接受了医疗治疗。建议的研究是一项 爱荷华大学的研究人员和临床药剂师与来自 仁慈健康网络责任护理组织(ACO)，这是一个非学术医疗系统 在爱荷华州的农村社区有很大的影响力。利用与Mercy ACO的现有合作伙伴关系，我们 将使用有效性-实施混合设计来实现以下具体目标：(1)检查 以临床为基础的个体化用药护理计划在降低就诊率方面的有效性 农村老年人跌倒(次级目标1a)和机动车充电和撞车(次级目标1b) 初级保健诊所，(2)确定与患者遵守 停药和停药建议，以及(3)评估执行情况 药物护理计划，以了解其在医疗系统中的可接受性、可用性和相关性 行政人员、诊所(诊所经理和临床工作人员)、提供者(健康教练、药剂师、处方医生) 和病人。实现这些目标将产生一个框架，说明如何制定个性化的药物护理计划， 开发用于减少老年人中接受药物治疗的跌倒，可以通过 医疗保健系统，并由老年人实施。

PROJECT ABSTRACT Falls are the leading cause of unintentional fatal and nonfatal injury among older adults in the United States. In Iowa, rates of fall-related deaths and hospitalizations among older adults are higher than the national average. More than one-third of older adults fall each year in the U.S., and many of these falls result in injury, decreased or permanent loss of functioning, loss of independence and a fear of falling. We know that certain medications, including those that affect the central nervous system (CNS), increase the risk of a fall among older adults and that interventions targeting withdrawal of these medications reduce falls and fall-related injuries. We also know that reaching high-risk older adults, including those living in rural communities, with falls prevention programs can be challenging. On their own, older adults do not typically engage in falls prevention behaviors and often report that limited support from healthcare providers is a barrier to participation in falls prevention programs. The long-term goal of the proposed study is to develop a sustainable program for healthcare systems to reduce fatal and nonfatal falls among high-risk older adults living independently in their communities. The objective of the proposed study is to examine how a medication care plan, grounded in established medication de-prescribing and tapering frameworks, can be implemented in primary care clinics to reduce medically-treated falls among older adults living in rural Iowa communities. The proposed study is a collaboration between researchers and clinical pharmacists at the University of Iowa and a clinical team from the Mercy Health Network Accountable Care Organization (ACO), which is a non-academic healthcare system with significant reach into rural Iowa communities. Leveraging an existing partnership with the Mercy ACO, we will use an effectiveness-implementation hybrid design to accomplish the following specific aims: (1) Examine the effectiveness of a clinic-based, individualized medication care plan in reducing rates of medically treated falls (sub-aim 1a) and motor vehicle charges and crashes (sub-aim 1b) among older adults seen in rural primary care clinics, (2) Identify provider and patient factors that are associated with patient adherence to medication deprescribing and discontinuation recommendations, and (3) Evaluate implementation of the medication care plan to understand its acceptability, usability and relevance among healthcare system administrators, clinics (clinic managers and clinical staff), providers (health coaches, pharmacists, prescribers) and patients. Accomplishing these aims will result in a framework for how individualized medication care plans, developed to reduce medically treated falls among older adults, can be effectively disseminated through a healthcare system and implemented by older adults.