Guideline Adherence in Elders With Multiple Comorbidities

患有多种合并症的老年人遵守指南的情况

基本信息

批准号：
7690786
负责人：
MICHAEL A. STEINMAN
金额：
$ 12.52万
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：
2008
资助国家：
美国
起止时间：
2008-09-30 至 2011-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7690786
关键词：
Accounting Adverse drug effect Adverse effects Adverse event Adverse reactions Age Aging Applications Grants Attitude Award Cardiovascular system Characteristics Clinic Clinical Trials Cognitive Cohort Studies Comorbidity Data Development Disease Drug Prescriptions Elderly Enrollment Equilibrium Event Focus Groups Foundations Future Goals Group Interviews Group Structure Guideline Adherence Hand Hospitals Impaired cognition Impairment Individual Intervention Intervention Studies Interview Knowledge Life Measurement Measures Methods Morbidity - disease rate Patient Care Patients Persons Pharmaceutical Cares Pharmaceutical Preparations Pharmacists Pharmacotherapy Physicians Prevention Process Public Health Reaction Research Research Personnel Risk Risk Factors Risk Reduction Running San Francisco Services Social support System Techniques Telephone Interviews Testing Time Transcript Translating Validation age related base career development clinical care clinical practice cohort design evidence base experience follow-up frailty high risk improved improved functioning indexing insight instrument mortality prevent programs prospective risk mitigation skills social tool

项目摘要

DESCRIPTION (provided by applicant): Rationale: Adverse drug reactions (ADRs) are common and often severe in ambulatory elders. However, little is known about how classically "geriatric1 features such as frailty impact ADR risk, and few clinically- useful tools exist to quantify the risk of ADRs in individual older persons. Research objectives / aims: Our aims are (1) to determine risk factors for adverse drug reactions in elders, with a particular focus on geriatric features including physical, cognitive, and social vulnerability; (2) to develop and validate a prediction tool to assess ADR risk in elders; and (3) to use clinician focus groups and interviews to refine and pilot test an intervention based on the ADR risk prediction index. At the conclusion of the Beeson Award period, we will submit a R01 grant proposal to test this intervention. Methods: We will assemble and follow a prospective cohort of 400 elders following discharge from two San Francisco hospitals. Through serial telephone interviews and chart review, we will use validated methods to identify and characterize adverse drug reactions and to collect information on a variety of potential risk factors. For Aim (3), we will conduct focus groups and structured cognitive interviews to refine and then pilot test an intervention based on the ADR risk index. Analyses: For Aim 1, we will use mixed-efforts Poisson regression to determine risk factors for ADRs. For Aim 2, we will use standard techniques to develop and validate a risk prediction index for ADRs. For Aim 3, we will use qualitative techniques to analyze focus group and interview transcripts for relevant content. Relevance to public health: Quantifying ADR risk in elders can improve clinical care by helping clinicians weigh the benefits vs. harms of drug therapy and by targeting high-risk elders for systems-based interventions to reduce ADRs and improve prescribing. The proposed research will obtain data to support a future intervention study whose goal is to reduce ADRs and improve prescribing for elders.

描述（由申请人提供）：理由：药物不良反应 (ADR) 在走动的老年人中很常见，而且往往很严重。然而，人们对虚弱等典型的“老年特征”如何影响 ADR 风险知之甚少，也很少有临床上有用的工具来量化个别老年人的 ADR 风险。研究目的/目标：我们的目标是（1）确定老年人药物不良反应的危险因素，特别关注老年人特征，包括身体、认知和社会脆弱性； (2) 开发并验证评估老年人 ADR 风险的预测工具； (3) 利用临床医生焦点小组和访谈来完善和试点测试基于 ADR 风险预测指数的干预措施。在 Beeson 奖期结束时，我们将提交 R01 拨款提案来测试这一干预措施。方法：我们将收集并追踪 400 名从旧金山两家医院出院的老年人的前瞻性队列。通过系列电话访谈和图表审查，我们将使用经过验证的方法来识别和表征药物不良反应，并收集有关各种潜在风险因素的信息。对于目标 (3)，我们将进行焦点小组和结构化认知访谈，以完善并试点测试基于 ADR 风险指数的干预措施。分析：对于目标 1，我们将使用混合努力泊松回归来确定 ADR 的风险因素。对于目标 2，我们将使用标准技术来开发和验证 ADR 的风险预测指数。对于目标 3，我们将使用定性技术来分析焦点小组和访谈记录中的相关内容。与公共卫生的相关性：量化老年人的 ADR 风险可以帮助临床医生权衡药物治疗的利弊，并针对高危老年人进行基于系统的干预措施，以减少 ADR 并改善处方，从而改善临床护理。拟议的研究将获得数据来支持未来的干预研究，其目标是减少不良反应并改善老年人的处方。