Evaluation of treatment patterns and prescription medication use among older adults with late-onset rheumatoid arthritis

晚发性类风湿性关节炎老年人的治疗模式和处方药使用评估

• 批准号: 10027364
• 负责人: JIHA LEE
• 金额: $ 15.41万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-15 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10027364
• 关键词: Acute; Address; Adverse effects; Affect; Age; Aging; Americas; Award; Behavior; Biological; Capsicum; Caring; Characteristics; Chronic; Clinical; Complex; Cost of Illness; Data; Data Analyses; Development; Diagnosis; Diagnostic radiologic examination; Disease; Disease remission; Disease-Modifying Second-Line Drugs; Dose; Drug Prescriptions; Drug usage; Elderly; Eligibility Determination; Emergency department visit; Evaluation; Fracture; Frequencies; Future; Glucocorticoids; Goals; Health; Healthcare; Hospitalization; Incidence; Infection; Inflammation; Inflammatory; K-Series Research Career Programs; Knowledge; Life Expectancy; Medical; Medicare; Medicare claim; Mentors; Mentorship; Michigan; Modeling; Non-Steroidal Anti-Inflammatory Agents; Observational Study; Older Population; Opioid; Osteoporosis; Outcome; Outcome Measure; Pain management; Patients; Pattern; Pharmaceutical Preparations; Polypharmacy; Population; Population Study; Quality of Care; Randomized Controlled Trials; Regimen; Research; Research Personnel; Resources; Retrospective cohort study; Rheumatism; Rheumatoid Arthritis; Risk; Role; Training; Treatment Protocols; Universities; Variant; aggressive therapy; career; career development; cohort; cost; design; disability; education research; experience; fall risk; functional decline; functional outcomes; health care delivery; high risk; human old age (65+); improved; improved outcome; indexing; interest; multiple chronic conditions; older patient; opioid use; public health relevance; skills; treatment as usual; treatment choice

PROJECT SUMMARY / ABSTRACT Rheumatoid arthritis (RA) is a chronic, debilitating and costly disease that disproportionally affects older adults. Disease modifying antirheumatic drugs (DMARDs) improve outcomes of RA and, in recent years, the treatment paradigm has evolved to promote early initiation, escalation, and combination of DMARDs. And yet, older adults are less likely to receive aggressive treatment due to issues of polypharmacy and multimorbidity. Older adults with late-onset RA (LORA) experience higher disease activity, more radiographic progression, and greater functional decline. Thus, less aggressive treatment raises greater concerns for poorer outcomes and greater levels of disability among older adults with LORA. In addition to achieving disease remission, pain control is an important goal in the treatment of RA and prescription medications including NSAIDS, glucocorticoids and opioids are in common use among patients with RA. However, these prescription medications are generally considered inappropriate for use in older adults because of associated adverse effects such as risk of falls, fractures and osteoporosis. Moreover, older adults have more limited tolerance to common adverse effects of medications and are more prone to the additive or even multiplicative risk of polypharmacy, further complicating the care of medically complex older adults with RA. Information on use of DMARDs for new diagnosis of LORA, and potential unintentional reliance on other prescription medication use is scarce because older adults are often excluded from randomized controlled trials. This leaves a gap in our understanding of how, in the face of polypharmacy and multimorbidity, variation in patterns of treatment impact outcomes for medically complex older adults with RA. In the absence of trial data, large observational studies that leverage administrative data serve an important role in filling this type of scientific knowledge gap and also allow for understanding drivers of treatment choices in usual care. In this retrospective cohort study using Medicare data we propose to achieve 2 aims. In Aim 1, we will characterize patterns of and factors associated with DMRADs and other prescription medication use among older adults with a new diagnosis of LORA. And in Aim 2 we will compare outcomes related to treatment and timing of DMARD-initiation for new cases of LORA. This proposal provides a real-world and population-level study of the care received by older RA patients treated with DMARDs. Preliminary data and analyses obtained from this study will form the basis of future career development awards to address unique challenges related to prescribing high risk medications for older adults. Support from the GEMSSTAR award, mentorship, and training will be invaluable as I progress towards a career as an independent researcher focused on the design, implementation and evaluation of care models to improve quality of care in older patients with rheumatic diseases.

项目摘要 /摘要 类风湿关节炎（RA）是一种慢性，令人衰弱和昂贵的疾病，对老年人的影响不成比例。 修饰抗疾病药物（DMARDS）的疾病改善了RA的预后，近年来 范式已经演变为促进dmards的早期开始，升级和组合。但是，老年人 由于多药和多种病的问题，因此不太可能接受积极的治疗。老年人 随着迟到的RA（LORA）经历较高的疾病活动，更多的影像学进展和更大的 功能下降。因此，不太积极的待遇引起了人们对较差的结果和更大的关注 洛拉老年人的残疾水平。除了增加疾病缓解外，疼痛控制是 治疗RA和处方药的重要目标，包括NSAID，糖皮质激素和 RA患者常用阿片类药物。但是，这些处方药通常是 由于相关的不利影响，例如跌倒风险，被认为不适合在老年人中使用 骨折和骨质疏松症。此外，老年人对常见不良影响的容忍度更高 药物，更容易容易出现多种药物的添加剂甚至乘法风险，使得进一步复杂化 对医学复杂的老年人的护理。有关使用DMARD进行新诊断的信息的信息， 而且潜在的无意依赖其他处方药的使用是稀缺的，因为老年人经常是 从随机对照试验中排除。这给我们的理解留下了差距 多药和多种病态，治疗模式的变化影响医学上的复杂较老的结果 患有RA的成年人。在没有试验数据的情况下，大量的观察性研究利用行政数据服务 填补这类科学知识差距的重要作用，还可以理解 通常护理中的治疗选择。在这项回顾性队列研究中，我们建议我们实现2 目标。在AIM 1中，我们将表征与DMRAD和其他处方相关的模式和因素 老年人的药物使用，并具有新的洛拉诊断。在AIM 2中，我们将比较结果 与新的洛拉病例的dmard-Itiation的治疗和时间有关。该建议提供了一个现实世界 以及对接受DMARDS治疗的老年RA患者接受的护理的人口水平研究。初步数据和 从这项研究获得的分析将构成未来职业发展奖的基础，以解决独特 与为老年人开处方高风险药物有关的挑战。 Gemsstar奖的支持， 随着我以独立研究人员为重点的职业，指导和培训将是无价的 关于护理模型的设计，实施和评估，以改善老年患者的护理质量 风湿病。