Optimizing Care for Older Adults through Thyroid Hormone Deprescribing

通过减少甲状腺激素处方来优化老年人的护理

• 批准号: 10733478
• 负责人: Maria Papaleontiou
• 金额: $ 79.57万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2028-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10733478
• 关键词: Abbreviations; Adoption; Adult; Adverse event; Advocate; American; Atrial Fibrillation; Attitude; Behavior; Biochemical; Biochemical Markers; California; Canada; Cardiovascular system; Caring; Clinical; Computerized Medical Record; Deimplementation; Dose; Drug Prescriptions; Education; Elderly; Endocrine; Endocrine System Diseases; Endocrinologist; Funding Agency; Growth; Guidelines; Happiness; Health system; High Prevalence; Hormone use; Hypothyroidism; Intervention; Interview; Knowledge; Letters; Maintenance; Michigan; Mission; Modeling; Monitor; Normal Range; Osteoporosis; Ownership; Pamphlets; Patients; Pharmaceutical Preparations; Pharmacologic Substance; Pilot Projects; Polypharmacy; Prevalence; Primary Care; Provider; Public Health; Quebec; Randomized; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Research; Risk; San Francisco; Self Efficacy; Site; Surveys; System; Testing; Thyroid Gland; Thyroid Hormones; Thyroid Nodule; Thyrotropin; Thyroxine; United States; United States National Institutes of Health; Universities; aged; clinical practice; effectiveness evaluation; effectiveness/implementation trial; evidence base; hormone therapy; implementation facilitators; implementation outcomes; innovation; mortality; multi-site trial; novel; optimism; overtreatment; primary outcome; process evaluation; secondary outcome; skeletal; success; treatment as usual

Abstract/Project Summary Older adults have a disproportionately higher prevalence of hypothyroidism compared to their younger counterparts, with levothyroxine (the most widely used synthetic thyroid hormone) consistently one of the top most frequently prescribed medications in the United States. Alarmingly, up to 48% of older adults aged 65 years receive a thyroid hormone dose that is too high, resulting in overtreatment. In addition, thyroid hormone therapy is often initiated for inappropriate indications (misuse) which can also lead to overtreatment. This is especially concerning for older adults, who comprise the fastest growing demographic group and the most vulnerable to polypharmacy. Studies conducted by our team and others have demonstrated that thyroid hormone overtreatment can lead to significant cardiovascular and skeletal risks, and increased mortality. Despite potential patient harm, ~90% of patients continue lifelong thyroid hormone treatment. Thus, in the context of thyroid hormone overtreatment, there is a critical need to deprescribe, which can be achieved either via thyroid hormone dose de-escalation (in patients overtreated) or thyroid hormone discontinuation (in patients without an appropriate indication). The proposed study is the first multi-site trial to evaluate a novel evidence-based adapted multilevel intervention, D-THIO (Deprescribing Thyroid Hormone In Older Adults), consisting of evidence-based pharmaceutical opinion letters to providers, education brochures to patients and facilitated by clinical champions, to support thyroid hormone deprescribing in older adults. We will conduct a type 1 hybrid effectiveness- implementation trial of D-THIO vs. enhanced usual care (American Thyroid Association [ATA] provider abbreviated guidelines, ATA patient brochure) at 3 sites (University of Michigan, Henry Ford, University of California San Francisco) in 150 providers (primary care, endocrinologists, geriatricians, advance practice providers) and 750 of their patients 65 years overtreated with thyroid hormone. We will randomize 1:1 at the provider level within each site. We propose three specific aims: 1) to assess the effectiveness of D-THIO on thyroid hormone deprescribing by providers and on reducing overtreatment and misuse with thyroid hormone via EMR, 2) to assess the effectiveness of D-THIO on provider and patient knowledge and attitudes regarding thyroid hormone deprescribing via surveys, and 3) to identify factors related to the implementation of D-THIO across diverse general care settings via post-trial interviews with key stakeholders. Ultimately, our findings will serve as a model for deprescribing inappropriate medications for other endocrine conditions and conditions with biochemical monitoring, and advance our understanding of de-implementation of low-value care in older adults across the nation.

摘要/项目摘要 与年轻人相比，老年人的甲状腺功能减退症患病率更高 对应物与左甲状腺素（最广泛使用的合成甲状腺骑马酮）始终是顶部之一 在美国，最常开处方的药物。令人震惊的是，多达48％的老年人65 几年会接受甲状腺果子剂量过高，导致过度治疗。此外，甲状腺犬 治疗通常用于不适当的适应症（MISSU），这也可能导致过度治疗。这是 特别是对于老年人而言，他们建立了增长最快的人群群体和最多的人群 容易遭受一多兵的影响。我们的团队和其他人进行的研究证明了甲状腺同性恋 过度治疗会导致严重的心血管和骨骼风险，并增加死亡率。尽管潜力 患者的伤害，约90％的患者继续终身甲状腺马内治疗。在甲状腺的背景下 马龙过度治疗，至关重要的描述，可以通过甲状腺马酮来实现 剂量去降低（在患者中过度治疗）或甲状腺hors曲纳中断（在没有患者的患者中 适当的指示）。拟议的研究是第一次评估新型循证适应的多站点试验 多级干预，D-Thio（老年人的甲状腺激素脱粒），由循证基于证据 给提供者的药品意见书，给患者的教育手册，并由临床冠军促进 支持老年人的甲状腺马对甲状腺脱落。我们将进行1型混合有效性 - D-Thio与增强的常规护理的实施试验（美国甲状腺协会[ATA]提供者 缩写指南，ATA患者手册）位于3个地点（密歇根大学，亨利·福特，大学，大学 加利福尼亚州旧金山）在150个提供者（初级保健，内分泌学家，老年医生，提前练习 提供者）和750名患者65年过度治疗甲状腺激素。我们将在 每个站点中的提供商级别。我们提出了三个具体目标：1）评估D-Thio对 甲状腺马对提供者的分类，并减少过度治疗和与甲状腺甲状腺 通过EMR，2）评估D-Thio对提供商和患者知识的有效性，并参加 甲状腺马酮通过调查进行排除，3）确定与实施D-Thio有关的因素 在潜水员的一般护理环境中，通过与主要利益相关者进行审判后的访谈。最终，我们的发现将 用作对其他内分泌条件和条件的不当药物的模型 生化监测，并促进我们对老年人低价值护理的实现的理解 整个国家。