Reducing Polypharmacy and Fall Risk for Multi-Morbid Adults with Chronic Obstructive Pulmonary Disease

减少患有慢性阻塞性肺病的多种疾病成人的多重用药和跌倒风险

基本信息

批准号：
10447983
负责人：
Cara Lyn McDermott
金额：
$ 18.16万
依托单位：
DUKE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-01 至 2026-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10447983
关键词：
Academic Medical Centers Address Adult Award Behavior Therapy Benzodiazepines Caregivers Caring Cessation of life Chronic Obstructive Pulmonary Disease Clinic Clinical Clinical Trials Clinical Trials Design Communication Communities Data Databases Drug Combinations Drug usage Emergency department visit Evaluation Evidence based intervention Family Caregiver Funding Future Goals Health Hospitalization Hospitals Incidence Individual Injury Intervention Intervention Trial Interview Knowledge Learning Lung Measures Medication Management Morbidity - disease rate Muscle relaxants National Heart, Lung, and Blood Institute Opioid Outpatients Oxygen Pain Participant Patients Pharmaceutical Preparations Pharmacists Polypharmacy Population Primary Health Care Quality of life Questionnaires Recording of previous events Reporting Research Risk Risk Assessment Scientist Sleeplessness Source Statistical Methods Structure Symptoms Testing Therapeutic Time Training Treatment Efficacy Tricyclic Antidepressive Agents Visit Withdrawal Work anxiety symptoms base behavioral clinical trial care outcomes care providers career comparative efficacy cost effectiveness implementation study effectiveness implementation trial fall injury fall risk falls frailty functional status health care delivery high risk hypnotic implementation science improved individual patient innovation intervention participants medical specialties medication safety mortality novel patient oriented patient population patient safety pilot trial primary outcome programs randomized trial safety net sedative shared decision making symptom treatment treatment as usual

项目摘要

Project summary Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality in the US and results in significant reduction in quality of life and functional status. Patients with COPD are 55 times more likely to fall than patients without COPD, putting these patients at high risk of fall-related injuries and further decrements in quality of life and health. This study will tackle the common and important problem of use of fall- risk increasing drugs (FRIDs) among patients with COPD. This will be achieved by implementing and evaluating a pharmacist-led deprescribing intervention to reduce FRIDs use among community-dwelling, multi- morbid adults with COPD. The central hypothesis of this proposal is that poor communication and limited shared decision making between prescribers, patients, and patient caregivers represent modifiable barriers to deprescribing. Once these barriers are addressed, prescribers, patients and caregivers will be amenable to informed deprescribing as part of this targeted intervention. In Specific Aim 1, I will use a national database to assess commonly used FRIDs among patients with COPD, identifying FRID types and combinations associated with the highest fall risk. In Specific Aim 2, I will interview patients with COPD, their family caregivers, and clinicians (primary care providers, pulmonologists, pharmacists) to elicit barriers, facilitators and key strategies to deprescribing FRIDs and enhancing shared decision making between clinicians and patients. In Specific Aim 3, I will conduct a pilot randomized trial, testing a pharmacist-led deprescribing intervention, adapted using findings from Specific Aims 1 and 2. I will evaluate the feasibility, acceptability and appropriateness of the intervention using semi-structured interviews and structured questionnaires. I will also explore the preliminary efficacy of the intervention compared to usual care for the primary outcome of FRID discontinuation. This pilot trial will provide preliminary data for a future R01-funded hybrid effectiveness- implementation trial. This research is innovative in that: 1) no prior study has evaluated an intervention to facilitate deprescribing FRIDs among patients with COPD; 2) this intervention includes family caregivers, who provide informal medication management to patients; and 3) this project uses a pulmonary clinic-based pharmacist as a conduit to improve communication and shared decision making among patients, caregivers and clinicians. My learning objectives are to learn a) advanced statistical methods to evaluate fall risk among patients with COPD, b) training on COPD therapeutics and fall risk assessment, c) behavioral intervention optimization, adaptation and assessment, and d) behavioral clinical trials design for future intervention trials. My long-term career goals are to evaluate and disseminate evidence-based interventions to improve medication management and healthcare delivery for multi-morbid adults with COPD.

项目摘要慢性阻塞性肺疾病（COPD）是美国发病率和死亡率的主要原因，导致生活质量和功能状况的显着降低。 COPD患者的55倍可能比没有COPD的患者跌倒，使这些患者处于与跌倒有关的高风险中，进一步生活质量和健康的降低。这项研究将解决跌倒使用的常见和重要问题 - COPD患者中增加药物（FRID）的风险。这将通过实施和评估由药剂师主导的分离干预措施，以减少社区居住的多种病态的成年人患有COPD。该提议的核心假设是沟通不良和有限处方者，患者和患者护理人员之间的共同决策代表了可修改的障碍分类。一旦解决了这些障碍，处方者，患者和照顾者将适合作为该针对性干预的一部分，将其视为划分。在特定目标1中，我将使用国家数据库评估COPD患者中常用的FRID，识别frid类型和组合与最高的秋季风险相关。在特定的目标2中，我将采访COPD患者，他们的家人护理人员和临床医生（初级保健提供者，肺科医生，药剂师）引起障碍，促进者以及划分烦恼并增强临床医生与共同决策的关键策略患者。在特定的目标3中，我将进行一项试验随机试验，测试由药剂师主导的分类使用特定目的1和2的调查结果进行了干预，我将评估可行性，可接受性和使用半结构化访谈和结构化问卷调查干预的适当性。我也会探索干预措施的初步疗效，与FRID的主要结果相比中断。该初步试验将为未来R01资助的混合有效性提供初步数据 - 实施审判。这项研究具有创新性：1）没有先前的研究评估了干预措施促进COPD患者中的frids脱落； 2）此干预措施包括家庭护理人员为患者提供非正式的药物管理； 3）这个项目使用基于肺部诊所的项目药剂师作为改善患者沟通和共同决策的渠道，护理人员和临床医生。我的学习目标是学习a）评估跌倒风险的高级统计方法 COPD患者，b）COPD治疗和跌倒风险评估的培训，c）行为干预优化，适应和评估以及d）用于将来干预试验的行为临床试验设计。我的长期职业目标是评估和传播基于证据的干预措施以改进与COPD的多发性成年人的药物管理和医疗保健交付。