Medication changes in hospitalized older adults

住院老年人的药物变化

基本信息

批准号：
9903238
负责人：
MICHAEL A. STEINMAN
金额：
$ 18.27万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-04-01 至 2021-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9903238
关键词：
Accident and Emergency department Address Adherence Admission activity Adverse drug event Age Aging Area Attention Biological Models Blood Pressure Chronic Chronic Disease Clinical Communication Communities Complex Confusion Control Groups Data Databases Development Diabetes Mellitus Disease Elderly Emergency department visit Epidemiology Faculty Fostering Frequencies Funding Glucose Goals Healthcare Systems Hospitalization Hospitals Hypertension Inpatients K-Series Research Career Programs Laboratories Lead Length of Stay Linear Models Medical center Medicare Medication Errors Medicine Mentors Mentorship Methods Modification Outcome Patients Pharmaceutical Preparations Pharmacotherapy Pneumonia Polypharmacy Practice Guidelines Regimen Research Research Personnel Research Support Residencies Resources Retrospective cohort Serum Time Training Programs Urinary tract infection Veterans Work adverse drug reaction compliance behavior functional disability glycemic control hospital readmission hypertension control improved medication compliance multiple chronic conditions older patient overtreatment patient oriented public health relevance venous thromboembolism

项目摘要

DESCRIPTION (provided by applicant): Background: When older adults are hospitalized, they are often discharged on substantially different medication regimens than the ones they were using prior to admission. In this setting, errors of medication reconciliation and problems with medication adherence are common. To address these problems, much effort has focused on improving medication reconciliation and communication at the time of discharge. However, little attention has been paid to the medication changes themselves that happen during the hospital stay. These changes are often inappropriate, and can lead to medication confusion, non-adherence, and adverse drug reactions in the weeks and months after hospital discharge. This is particularly important for chronic diseases such as hypertension and diabetes, as medicines for these conditions may often be changed during the hospital stay and perpetuated at discharge despite having little relation to the reason for admission. Aims: (1) To determine the frequency and epidemiology of changes to medication regimens for hypertension and diabetes in older adults admitted to VA hospitals; (2) To evaluate the impact of these medication changes on medication persistence and adherence in the year after discharge; and (3) To evaluate the association between changes to chronic medications during the hospital stay and subsequent emergency department visits and hospital readmissions. Methods: Using national data from VA and Medicare, we will assemble a retrospective cohort of veterans age 65 years and older who had hypertension or diabetes and were hospitalized in a VA medical center with community-acquired pneumonia, urinary tract infection, or venous thromboembolism. (These conditions were chosen because they are common and are treated with a different set of medications than those used to manage hypertension and diabetes). Using claims data and targeted chart review, we will identify 500 patients who were discharged on more aggressive regimens for blood pressure and/or glycemic control than they were receiving prior to admission, and a control group of 500 patients without intensified regimens. We will use standard methods to evaluate persistence of and adherence to medications in the year after hospital discharge. We will use Cox regression and mixed effects generalized linear models to compare medication persistence and adherence in patients who were discharged from the hospital with a more intensive medication regimen vs. patients whose medication regimens were not intensified. We will use similar methods to determine the impact of medication changes during hospitalization on subsequent emergency department use and hospital readmission.

描述（由申请人提供）：背景：当老年人住院时，他们通常会以与入院前使用的药物相同的药物治疗方案出院。在这种情况下，药物和解的错误和药物依从性问题很常见。为了解决这些问题，很多努力都集中在出院时改善药物对帐和沟通。但是，很少关注医院住院期间发生的药物变化。这些变化通常是不合适的，并且可能在出院后的几周和几个月内导致药物混乱，不遵守和不良药物反应。这对于诸如高血压和糖尿病之类的慢性疾病尤为重要，因为这些疾病的药物在住院期间通常可能会改变，并且尽管与入院的原因无关，但仍会在出院时持续存在。目的：（1）确定接受VA医院的老年人的药物治疗方案变化的频率和流行病学；（2）评估出院后一年这些药物变化对药物持久性和依从性的影响；（3）评估医院住院期间慢性药物的变化与随后的急诊就诊和医院再入院之间的关联。方法：使用来自VA和Medicare的国家数据，我们将组装65岁及65岁以上的退伍军人的回顾群体，他们患有高血压或糖尿病，并在弗吉尼亚州医疗中心住院，并患有社区获得性肺炎，尿路感染，或静脉造成静脉血栓形成。（选择这些疾病是因为它们很常见，并且与用于管理高血压和糖尿病的药物相比，用不同的药物治疗）。使用索赔数据和有针对性的图表审查，我们将确定500名患者在血压和/或血糖控制方面出院的患者比入院前接受的患者和/或血糖对照，并且由500例没有加强方案的患者组成的对照组。我们将使用标准方法评估出院后一年对药物的持久性和依从性。我们将使用COX回归和混合效应普遍的线性模型来比较从医院出院的患者的药物持续性和依从性，并具有更强化的药物治疗方案与药物治疗方案未加强的患者。我们将使用类似的方法来确定住院期间药物变化对随后的急诊科使用和住院再入院的影响。