Therapeutic competition among diseases in elders: Frequency and outcomes

老年人疾病之间的治疗竞争：频率和结果

• 批准号: 8335470
• 负责人: MARY E TINETTI
• 金额: $ 6.81万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-30 至 2013-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8335470
• 关键词: Accounting; Address; Adherence; Affect; Age; Area; Awareness; Biology; Chronic Disease; Chronic Obstructive Airway Disease; Clinical; Comorbidity; Data; Diabetes Mellitus; Diagnosis; Diagnostic; Disease; Disease Outcome; Elderly; Ensure; Expenditure; Frequencies; Future; Guidelines; Health; Heart failure; Knowledge; Medical; Medicare; Morbidity - disease rate; Osteoporosis; Outcome; Participant; Persons; Pharmaceutical Preparations; Pilot Projects; Prevalence; Preventive; Research; Sampling; Source; Therapeutic; base; beneficiary; clinical decision-making; cohort; disease characteristic; medical specialties; member; outcome forecast; response; treatment effect; treatment response

DESCRIPTION (provided by applicant): In this pilot study, we begin to examine the prevalence and health effects of co-occurring chronic diseases for which there is potential therapeutic competition (i.e. the treatment of one disease worsens another disease or interferes with treatment response). We focus on therapeutic competition, one of several clinical dilemmas arising from multi-morbidity, because of the inherent potential to inflict harm. The Primary Aims are to determine: 1) the prevalence among older adults of the co- occurrence of selected chronic diseases for which there is potential therapeutic competition; and 2) whether there are differences in treatments received, and adhered to, by older adults with, vs. without, selected co-occurring conditions for which there is potential therapeutic competition. The exploratory aim is to determine whether health and disease-specific outcomes differ among older adults with a selected disease according to the treatment received for co-occurring diseases with potential therapeutic competition. The selected diseases for which we will evaluate the frequency and consequences of co-occurring diseases with potential therapeutic competition include diabetes, heart failure, COPD, and osteoporosis. For this pilot study, we focus on medications as the source of therapeutic competition. The co-occurring diseases with potential therapeutic competition with the selected diseases are chosen based on: 1) evidence; 2) biology of the diseases and treatments; and 3) disease specialty guidelines. Participants are members of 2 nationally representative longitudinal cohorts of older adults, both sampled from throughout the U.S. The Medical Expenditure Panel Study (MEPS) has over 11,000 and the Medicare Current Beneficiary Study (MCBS) over 18,000 participants age 65+ years. Both MEPS and MCBS include a wealth of longitudinal data on chronic diseases, disease treatments including medications, health outcomes, and disease-specific outcomes for the selected diseases. Results of this pilot study will heighten awareness and understanding of this important but understudied area and lay the methodological groundwork for future studies. The clinical dilemmas arising from the growing numbers of older adults with multi-morbidity mandate careful scrutiny to ensure that our diagnostic, preventive, and therapeutic armamentaria are deployed as safely and effectively as possible.

描述（由申请人提供）：在这项试验研究中，我们开始研究存在潜在的治疗竞争的同时发生慢性疾病的患病率和健康影响（即一种疾病的治疗使另一种疾病的治疗恶化或干扰治疗反应）。我们专注于治疗竞争，这是多个多元车引起的几个临床困境之一，因为造成伤害的固有潜力。 主要目的是确定：1​​）老年人的患病率是存在潜在的治疗竞争的选定慢性疾病； 2）在接受潜在的治疗竞争的同时存在的疾病中，接受的治疗是否存在差异，并遵守没有选定的同时发生条件。探索目的是确定患有选定疾病的老年人的健康和疾病特异性结果是否根据与潜在治疗竞争的同时发生疾病所接受的治疗方法有所不同。 我们将为其中评估与潜在治疗竞争的同时发生疾病的频率和后果所选择的疾病包括糖尿病，心力衰竭，COPD和骨质疏松症。在这项试点研究中，我们专注于药物作为治疗竞争的来源。基于以下方面选择了与选定疾病的潜在治疗竞争的共同疾病：1）证据； 2）疾病和治疗的生物学； 3）疾病专业指南。 参与者是来自美国的2个国家代表性纵向人群的成员，他们都是从美国取样的，医疗支出小组研究（MEPS）超过11,000，而Medicare当前的受益人研究（MCB）超过18,000名参与者65岁以上。 MEP和MCB都包含大量有关慢性疾病的纵向数据，包括药物，健康结果和针对选定疾病的疾病特异性结局的疾病治疗。 这项试点研究的结果将提高对这个重要但研究过的领域的认识和理解，并为未来的研究奠定了方法论基础。临床困境是由越来越多的多人授权的老年人仔细审查的，以确保尽可能安全有效地部署我们的诊断，预防和治疗性武器。