Effect of Medication Management at Home via Pharmacy Home Televisits

通过药房家庭电视访视在家进行药物管理的效果

基本信息

批准号：
10159114
负责人：
William W.,MPH, MD Hung
金额：
--
依托单位：
JAMES J PETERS VA MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-05-01 至 2024-09-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10159114
关键词：
Adherence Adverse drug event Adverse effects Caring Chronic Disease Client satisfaction Clinic Clinical Clinical Pharmacists Complex Data Drug Interactions Drug usage Education Effectiveness Elderly Home Hybrids Improve Access Intervention Interview Long-Term Care Measures Medication Management Methods Non-Prescription Drugs Outcome Patients Persons Pharmaceutical Preparations Pharmacists Pharmacy facility Predisposition Procedures Protocols documentation Provider Quality of Care Questionnaires Randomized, Controlled Trials Regimen Research Design Research Personnel Respondent Right to Treatments Screening procedure Site Structure Telemedicine Veterans Visit Visualization Writing design effectiveness evaluation effectiveness/implementation study future implementation implementation evaluation improved information gathering medication compliance medication nonadherence multiple chronic conditions post intervention primary outcome randomized trial secondary outcome success telehealth televisit treatment as usual uptake video visit

项目摘要

Older adults are more likely to suffer from multiple chronic conditions, to be prescribed multiple medications, and are more susceptible to adverse effects of medications. In addition, older adults often use over-the-counter medications and supplements, further complicating their medication regimen. Complex medication regimens are potentially harmful to older adults due to potential drug interactions, potentially inappropriate prescribing or over-the-counter drug use, and medication non-adherence that may lead to poor control of chronic disease. Interventions aimed at reducing medication discrepancy in the ambulatory clinic setting, such as the review of written medication lists, and implementation of “brown bag” reconciliation (asking patients to bring in all medication bottles for review in the clinic) continues to be challenging and have limited success. Clinical pharmacist led interventions to improve appropriate medication use in older adults, including the application of the START/STOPP criteria, have demonstrated effectiveness in reducing adverse drug events. With the increased capability of VA telemedicine to reach Veteran in their homes, delivering medication management via televisit by clinical pharmacists has the potential to yield similar benefits for a larger number of older Veterans. Telemedicine is an increasingly vital component within VHA to increase access and improve quality of care. By extending care beyond brick-and-mortar clinics, telemedicine increases the reach of care teams and is more convenient for patients, resulting in improved patient satisfaction. Using the capability of telemedicine to reach patients' homes, we propose to examine the effect of medication management by clinical pharmacists via home video televisits, as home video visits have the potential to provide direct visualization of medications in older adults' homes, thereby reducing medication discrepancy and increasing medication adherence. Pharmacist management for older adult medication regimen may also improve appropriate medication use in older adults through direct pharmacist-patient interview and education. In support of this application, preliminary data from our team of investigators demonstrate acceptability of video televisits by older adults, that there is good uptake by patients and VA providers, and that video televisits into the home are feasible. In this study, we aim to develop a protocol for pharmacy home televisits for medication management in older adults who have multiple chronic conditions and are on multiple medications. We will then conduct a randomized trial with hybrid effectiveness Type I design to examine the effect of these televisits on appropriate medication use, medication discrepancies, adherence and adverse drug events and observe and gather information on implementation. We anticipate that a pharmacist led medication management home televisit intervention will lead to reduction in potentially inappropriate use of medication, reduction in medication discrepancies, increased medication adherence and reduced adverse drug events in older adults compared to older adults receiving usual care. We will also examine the barriers and facilitators in implementing the intervention so that the study findings may inform future implementation.

老年人更有可能患有多种慢性病，需要服用多种药物药物治疗，并且更容易受到药物不良反应的影响。成年人经常使用非处方药和补充剂，这使他们的病情进一步复杂化复杂的药物治疗方案可能对老年人有害，因为潜在的药物相互作用、潜在的不当处方或非处方药物的使用，不坚持用药可能导致慢性病控制不佳。旨在减少门诊环境中的药物差异，例如审查书面药物清单，并实施“棕包”核对（要求患者将所有药瓶带到诊所进行检查）仍然具有挑战性，并且临床药剂师主导的干预措施改善了适当的药物使用，但取得的成功有限。老年人，包括 START/STOPP 标准的应用，已经证明随着 VA 远程医疗能力的增强，可有效减少药物不良事件。到达退伍军人家中，通过临床电视访问提供药物管理药剂师有潜力为更多老年退伍军人带来类似的好处。远程医疗是 VHA 中越来越重要的组成部分，可以增加访问和改善通过将护理扩展到实体诊所之外，远程医疗提高了护理质量。护理团队可以覆盖，对患者来说更加方便，从而改善患者的情况我们建议利用远程医疗到达患者家中的能力。通过家庭视频电视检查临床药剂师用药管理的效果，因为家庭视频就诊有可能为老年人提供药物的直接可视化成人家中，从而减少用药差异并提高用药依从性。药剂师对老年人用药方案的管理也可能会适当改善通过药剂师与患者的直接访谈和教育来了解老年人的药物使用情况。我们的研究团队的初步数据证明了该应用程序的支持老年人对视频电视的接受程度，患者和退伍军人管理局的接受程度很高提供商，并且视频电视进入家庭是可行的。在这项研究中，我们的目标是制定一个药房家庭电视就诊方案以获取药物患有多种慢性病并接受多种治疗的老年人的管理然后，我们将进行一项具有混合有效性 I 型设计的随机试验。检查这些电视访问对适当药物使用、药物差异的影响，依从性和药物不良事件，并观察和收集实施信息。我们预计药剂师主导的药物管理家庭电视访问干预将导致减少潜在的不当用药，减少用药差异，增加了老年人的药物依从性并减少了药物不良事件我们还将检查障碍和接受常规护理的老年人。实施干预措施的促进者，以便研究结果可以为未来提供信息执行。