Deprescribing for Older Dialysis Patients

取消老年透析患者的处方

基本信息

批准号：
9925719
负责人：
Rasheeda K Hall
金额：
$ 22.12万
依托单位：
DUKE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-08-01 至 2023-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9925719
关键词：
Address Adrenergic alpha-Antagonists Adverse effects Adverse event Affect Aging Agonist Antihypertensive Agents Area Attitude Award Capsicum Caregivers Caring Categories Cerebrovascular Disorders Client satisfaction Clinical Clinical Trials Clinical Trials Design Communities Data Decision Making Dialysis patients Dialysis procedure Diffusion of Innovation Elderly Elements End stage renal failure Environment Face Focus Groups Frequencies Future Goals Health Health system Hospitalization Hypotension Impaired cognition Individual Information Systems Institutes Intervention Interview K-Series Research Career Programs Kidney Kidney Diseases Knowledge Lead Leadership Medicare Mental Depression Mentors Methods Mission Nephrology Opioid Outcome Patient Preferences Patients Pattern Pharmaceutical Preparations Pharmacists Pharmacoepidemiology Physicians Physiological Pilot Projects Predisposition Prevalence Provider Quality of Care Quality of life Registries Renal function Research Research Design Resources Risk Scientist Stroke Structure Syndrome Testing Time United States Universities Vocational Guidance Withdrawal Work adverse outcome beneficiary care providers career development case-based cognitive function cohort contextual factors design effective intervention effectiveness evaluation evidence base experience falls health care quality health care service utilization hospitalization rates improved leadership development novel patient engagement preference primary outcome recruit research study shared decision making skill acquisition skills standard of care theories

项目摘要

ABSTRACT This is a Beeson Emerging Leaders in Aging career development award (K76) for Dr. Rasheeda Hall, MD, MBA, MHS. Dr. Hall is a nephrologist who conducts aging research at Duke University, and her long-term goal is to become a leader in geriatric nephrology and develop effective interventions targeting geriatric conditions in older dialysis patients. Compared to older adults without kidney disease, older dialysis patients are more likely develop severe cognitive impairment, experience more falls, and have more frequent hospitalizations. These adverse outcomes are also known to be associated with potentially inappropriate medications, and older dialysis patients are highly susceptible to adverse effects of potentially inappropriate medications because of altered medication clearance due to absent kidney function and common occurrences of hypotension and mini- strokes. Given this susceptibility, reduction of potentially inappropriate medications is a logical goal for improving quality of care for these vulnerable patients. The objective of Dr. Hall’s proposed research is to develop an evidence-based strategy to reduce inappropriate prescribing in older dialysis patients. The research aims are to: 1) identify the prevalence of specific potentially inappropriate medications and the extent to which there is an association with hospitalization risk in prevalent older dialysis patients, 2) identify elements of a deprescribing intervention that are acceptable to nephrologists, primary care providers, and patients, and 3) determine the feasibility of a deprescribing intervention tailored for older dialysis patients. This work will provide evidence to support a definitive clinical trial of deprescribing in dialysis units. Effective deprescribing interventions have the potential to reduce hospitalizations and ameliorate geriatric syndromes in dialysis patients which is consistent with NIA’s mission. Complementary to this research, this career development award will solidify Dr. Hall’s transition to research independence through coursework and mentoring to: a) fill knowledge gaps in directing a team of statisticians, interpretation of pharmacoepidemiologic data, advanced methods in handling bias in observational data, timely qualitative analyses, execution of a pilot study, and clinical trial design; b) enhance her leadership skills; and c) successfully compete for a R01. Duke University is the ideal environment for Dr. Hall to pursue this research career development because of the strong aging research expertise housed in its Center for Aging and affiliated Pepper Center, as well as, rich resources available through Duke’s Clinical and Translational Institute.

抽象的这是 Beeson 老年职业发展新兴领袖奖 (K76)，授予 Rasheeda Hall 博士，医学博士， Hall 博士是一位肾脏病学家，在杜克大学进行衰老研究，她拥有 MBA、MHS 学位，她的长期目标是成为老年肾病学领域的领导者，并针对老年疾病制定有效的干预措施与没有肾脏疾病的老年人相比，老年透析患者的发病率更高。可能会出现严重的认知障碍，经历更多的跌倒，并且更频繁地住院。众所周知，这些不良后果也与潜在的不适当药物有关，并且年龄较大透析患者非常容易受到潜在不适当药物的不良影响，因为由于肾功能缺失以及低血压和小血压的常见发生而改变药物清除率鉴于这种易感性，减少潜在的不适当药物治疗是一个合乎逻辑的目标。霍尔博士提出的研究目标是提高这些弱势患者的护理质量。制定基于证据的策略，以减少老年透析患者的不当处方。研究目的是： 1) 确定特定的潜在不适当药物的流行程度及其程度与流行的老年透析患者的住院风险相关，2) 确定要素肾脏科医生、初级保健提供者和患者可以接受的取消处方干预措施，以及 3）确定为老年透析患者量身定制的取消处方干预措施的可行性。提供证据支持透析单位取消处方的明确临床试验。干预措施有可能减少住院治疗并改善透析中的老年综合症这与 NIA 的使命相一致，是对这项研究和职业发展的补充。该奖项将通过课程作业和指导巩固霍尔博士向研究独立的过渡：a) 指导统计学家团队的知识差距、药物流行病学数据的解释、高级处理观察数据偏差的方法、及时的定性分析、试点研究的执行，以及临床试验设计；b) 提高她的领导能力；以及 c) 成功竞争杜克大学。由于老龄化严重，为霍尔博士追求这一研究事业发展提供了理想的环境其衰老中心和附属胡椒中心拥有研究专业知识以及丰富的资源可通过杜克大学临床和转化研究所获得。