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药物，更容易受到药物不良影响。另外，年龄较大成年人经常使用非处方药和补品，使他们的复杂药物治疗方案。复杂的药物治疗方案可能对老年人有害潜在的药物相互作用，可能不适当的处方或非处方药物使用，药物不遵守可能导致对慢性疾病的控制不佳。干预措施旨在减少门诊诊所环境中的药物差异，例如书面药物清单和实施“棕色袋子”和解（要求患者在诊所中引入所有药物瓶以进行审查）仍然具有挑战性，并且有限的成功。临床药剂师LED干预措施，以改善适当的药物使用老年人（包括使用开始/停止标准）已证明减少不良药物事件的有效性。随着VA远程医疗的能力增加要在他们家中吸引老兵，通过临床进行电视转播提供药物管理药剂师有可能对较大的老年退伍军人产生类似的好处。远程医疗是VHA中越来越重要的组成部分，以增加访问和改进护理质量。通过将护理扩展到实体诊所之外，远程医疗可以增加护理团队的范围，对于患者来说更方便，导致患者改善满意。使用远程医疗的能力来覆盖患者的家，我们建议检查临床药剂师通过家庭视频Televisits检查药物管理的效果，由于家庭视频访问有可能直接可视化较老的药物成人的房屋，从而减少了药物差异并增加了药物依从性。老年人药物治疗方案的药剂师管理也可以改善适当的通过直接的药剂师访谈和教育，老年人使用药物。在我们的调查人员团队的初步数据证明了此应用程序的支持老年人对视频电视的可接受性，患者有很好的吸收和VA 提供者，以及电视转播到房屋的视频是可行的。在这项研究中，我们旨在为药物的药房家庭电视节目制定协议具有多个慢性疾病并且多重疾病的老年人的管理药物。然后，我们将进行I型I型混合有效性的随机试验检查这些电视对适当用药的影响，药物差异，依从性和不良毒品事件，并观察并收集有关实施的信息。我们预计药剂师LED药物管理家庭电视干预将领导减少可能不适当使用药物，减少药物差异，增加的药物依从性和减少较老的不良药物事件与接受常规护理的老年人相比。我们还将检查障碍和实施干预措施的促进者，以使研究结果可能为未来提供信息执行。