Improving Medication Therapy for Older Patients with Common Co-morbidities

描述(由申请人提供)：总体目标是改善患有多种疾病的老年人的药物使用情况。我们的第一步将是从具有代表性的大型老年男性和女性群体的数据库(退伍军人管理局老年男性数据库和老年和高龄男性疗养院数据库(S))中，确定具有多种并存模式的老年人中处方问题的患病率、类型和严重程度。下一步将是开发“潜在优化处方(POP)”算法，预计这种算法将导致开出的药物更少，不良反应更少，并且对老年患者合适和有效。制定过程将考虑每种疾病的临床实践指南、用于治疗疾病的药物的药理特性和相互作用(药代动力学和药效学)，以及老年条件(功能、预计寿命、对脆弱老年人的护理)，这将改变治疗这种疾病的方法。然后，来自实践指南、临床药理学和药剂学、老年病学和卫生保健利用等医学学科的专家将对建议的优化治疗组合进行评估和修改。确定的潜在优化方案将被用来设计随后的优化组合和“常规”治疗的比较有效性研究。 公共卫生相关性：老龄化往往伴随着越来越多的与健康相关的诊断和更多的药物使用。服用多种药物或“多药联用”会增加老年患者因药物相关问题而发生药物相互作用和住院治疗的风险。更好地了解当前的药物问题并开发改进的药物治疗方案可以极大地造福于绝大多数老年人或其他有多种医疗问题的人。

DESCRIPTION (provided by applicant): The overall goal is to improve the use of medications for older people with multiple medical disorders. Our first step will be to Identify the prevalence, type and severity of prescribing problems in older people with defined patterns of multiple co-morbidities ("morbidotypes") from databases of representative large groups of older men and women (Veterans Administration databases for older men and Nursing home database (s) for older and very old women and men). The next step will be to develop "potentially optimized prescribing (POP)" algorithms that would be predicted to result in fewer medications prescribed, fewer unwanted effects, and be appropriate and efficacious for the older patient. The development process will consider clinical practice guidelines for each disorder, pharmacologic properties and interactions of medications used for the disorders (pharmacokinetic and pharmacodynamic), and geriatric conditions (function, projected length of life, care for vulnerable elderly) that would modify the approach to treatment of the disorder. The proposed optimized therapeutic combinations will then be evaluated and modified by experts from medical disciplines of the practice guidelines, clinical pharmacology and pharmacy, geriatrics, and health care utilization. The potentially optimized regimens identified will be used to design a subsequent comparative effectiveness study of the optimized combinations and "usual" therapy. PUBLIC HEALTH RELEVANCE: Aging is often accompanied by increasing numbers of health-related diagnoses and increased use of medications. Consumption of multiple medications or "polypharmacy" puts the older patient at increased risk for drug interactions and hospitalizations due to drug-related problems. Better understanding of current medication problems and development of improved medication therapy regimens could greatly benefit the vast majority of older people, or others, with multiple medical problems.