Mitigating Benzodiazepine and Sedative Use in the Hospital through Inpatient Deprescribing

通过住院减药减少医院内苯二氮卓类药物和镇静剂的使用

基本信息

批准号：
10076575
负责人：
Joshua M Pevnick
金额：
$ 17.25万
依托单位：
CEDARS-SINAI MEDICAL CENTER
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：
2018-09-01 至 2022-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10076575
关键词：
Address Adopted Adverse drug event Adverse event American Benzodiazepines Budgets Businesses Caring Cessation of life Clinical Research Communities Complex Counseling Country Disease Management Doctor of Pharmacy Doctor of Philosophy Economics Elderly Emergency department visit Ensure Face Funding Geriatrics Goals Grant Health Health Care Costs Health system Hospitalization Hospitals Human Resources Inpatients Institution Intervention Knowledge Lead Light Literature Measures Medical Medication Errors Medication Management Methodology Methods Modeling Monitor Morbidity - disease rate Older Population Organizational Change Outcome Outpatients Patients Pharmaceutical Preparations Pharmacists Pharmacy facility Physiological Polypharmacy Prevalence Process Publishing Qualitative Methods Randomized Controlled Trials Regimen Reporting Research Research Personnel Resources Review Literature Risk Sample Size Secondary to Services Site Societies Surrogate Endpoint Telephone Testing Time Training Update attributable mortality cost design dissemination research evidence base experience health care service utilization high risk hospital readmission improved information organization innovation intervention effect member mortality multidisciplinary patient subsets pragmatic trial prevent randomized trial sedative side effect social success

项目摘要

The sickest patients in the community are recently hospitalized elders. A substantial component of their morbidity and mortality is caused by adverse drug events (ADEs). ADEs account for 70% of adverse events occurring after discharge, which occur at a rate of 0.30 ADEs per patient. The oldest, sickest patients are at highest risk for ADEs because they have the most complex and hazardous medication regimens yet the least physiologic reserve and the fewest social and economic resources. Several studies, including our own, have demonstrated the efficacy of pharmacist-led post-discharge interventions to improve medication management. Most prominent among these have been post-discharge phone calls from pharmacists to patients. However, despite demonstrated efficacy, these interventions have not been widely implemented. In this proposal, we use the RE-AIM model to understand and address gaps in existing research that have hindered implementation. The central knowledge gap is that most research focuses on process or surrogate endpoint measures (like medication discrepancies) that we now understand to be insufficient to motivate organizational change. In contrast, we will measure the effect on utilization, a closely-tracked outcome that strongly motivates hospital leaders. We will use a large randomized controlled trial to rigorously assess the effect of PHARM-DC on this outcome. We will also study the barriers and facilitators of adopting these interventions, about which little is known. Finally, although implementation costs are critically important information for organizations considering pharmacist-led discharge (PHARM-DC) interventions, evidence on this topic is scarce. We thus aim to measure the impact of PHARM-DC interventions on post-discharge utilization within 30 days. We will also identify patient sub-populations most likely to benefit from PHARM-DC. Finally, we will estimate the incremental net cost of PHARMs from the health system perspective. To study these aims, we have selected two sites that: 1) are already proficient at in-hospital medication reconciliation, a prerequisite for implementing and evaluating PHARM-DC; 2) have a Chief Pharmacy Officer committed to using operational resources to provide PHARM-DC to patients during the study period; and 3) have investigators experienced in the research content and methodologies needed to study the aforementioned aims. This project will generate new knowledge allowing for increased implementation and dissemination of research already known to be efficacious, thus reducing the substantial morbidity and mortality attributable to ADEs among seniors in the high risk post-discharge time period.

社区中最病的患者最近是住院的长老。他们的重要组成部分发病率和死亡率是由不良药物事件（ADE）引起的。 ADE占不良事件的70％出院后发生，每位患者的速度为0.30。最古老，最病的患者在 ADE的最高风险是因为它们具有最复杂和危险的药物方案但最少生理储备和最少的社会和经济资源。包括我们自己在内的几项研究证明了药剂师主导后的发电后的功效改善药物管理的干预措施。其中最突出的是后收费药剂师打来电话给病人。然而，尽管有疗效，但这些干预措施有没有被广泛实施。在此提案中，我们使用re-aim模型来理解和解决差距现有的研究阻碍了实施。核心知识差距是大多数研究专注于我们现在了解的过程或替代端点措施（例如药物差异）不足以激发组织变革。相比之下，我们将衡量对利用的影响紧密地追踪的结果强烈激发了医院领导。我们将使用大型随机控制严格评估Pharm-DC对此结果的影响。我们还将研究障碍和采用这些干预措施的促进者，鲜为人知。最后，尽管实施成本对于考虑药剂师主导的组织（Pharm-DC）的组织，至关重要的信息非常重要干预措施，关于此主题的证据很少。因此，我们旨在衡量Pharm-DC的影响 30天内的干预后使用后利用措施。我们还将确定大多数患者子人群可能受益于Pharm-DC。最后，我们将从卫生系统的观点。为了研究这些目标，我们选择了两个：1）已经精通医院药物和解，实施和评估Pharm-DC的先决条件； 2）有一名首席药房官在研究期间，致力于使用操作资源为患者提供药物-DC； 3）是否有研究人员在研究研究内容和方法中经验丰富上述目标。该项目将产生新知识，以增加实施和传播已知已经有效的研究，从而降低了可归因于高风险分期后的高风险中的老年人中的AD。