Implementation of a De-prescribing Medication Protocol to Evaluate Falls in Older Adults

实施取消处方药物治疗方案以评估老年人跌倒

• 批准号: 10238728
• 负责人: JAN BUSBY-WHITEHEAD
• 金额: $ 75万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-30 至 2022-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10238728
• 关键词: Implementation; De; prescribing; Medication; Protocol

Abstract The proposed study will engage health care professionals (HCPs) to screen older adult patients at risk for falls. We will use the Stopping Elderly Accidents, Deaths and Injuries (STEADI) toolkit so all HCPs can identify patients at risk for falling within outpatient primary care clinics within the UNC Health Care System. These patients will be identified using an electronic health record (EHR) from UNC Health Care. Patients who are 65 years of age or older and taking either one opioid or benzodiazepine (BZD) will be included in the study. These clinics will engage the identified patients at risk for falls, educate patients on the risk of falls and injury posed by their opioid or BZD medication(s), and implement a de-prescribing medication protocol with a multidisciplinary team. Prior research indicates that opioid and benzodiazepine medications are among the most difficult to manage and least likely to result in a change. Given the country's current opioid crisis, our new approach will focus on educating HCPs on how to employ a de- prescribing protocol for these medications in older adults at risk for falls, incorporating alternate (and multidisciplinary) treatment modalities and/or medications where warranted. This proposed study will use a shared EHR to document answers to STEADI screening questions. We intend to create protocols specific to falls education as well as information about de-prescribing specific to BZDs and opioids, including alternate strategies for managing pain, insomnia, and/or anxiety. By using the EHR, we will be able to provide referral for fall prevention services beyond employing a de-prescribing protocol for opioid and BZD medications in older adults at risk for falls. We will be able to incorporate alternate (and multidisciplinary) treatment modalities and/or medications where warranted. This study will identify factors affecting the effectiveness, adoption, implementation, and maintenance of a de-prescribing program focused on BZDs and opioids with the intent of reducing falls. This will enable us to create guidelines for developing and implementing similar programs for other health systems across the United States.

抽象的 拟议的研究将让医疗保健专业人员 (HCP) 参与筛查老年患者 有跌倒的危险。我们将使用“阻止老年人事故、死亡和受伤”(STEADI) 工具包 因此，所有 HCP 都可以识别有可能在门诊初级保健诊所就诊的患者 北卡罗来纳大学医疗保健系统。这些患者将使用电子健康记录进行识别 (EHR) 来自北卡罗来纳大学医疗保健中心。 65 岁或以上并服用其中一种药物的患者 阿片类药物或苯二氮卓类药物 (BZD) 将被纳入研究中。这些诊所将聘请 识别有跌倒风险的患者，教育患者了解其跌倒和受伤的风险 阿片类药物或 BZD 药物，并实施取消处方药物治疗方案 多学科团队。先前的研究表明阿片类药物和苯二氮卓类药物 其中最难管理且最不可能产生变化。鉴于国家 当前的阿片类药物危机，我们的新方法将侧重于教育 HCP 如何采用 为有跌倒风险的老年人制定这些药物的处方方案，并纳入替代方案 （和多学科）治疗方式和/或药物（如有必要）。这个提议 研究将使用共享的 EHR 来记录 STEADI 筛查问题的答案。我们打算 创建专门针对跌倒教育的协议以及有关取消特定处方的信息 BZD 和阿片类药物，包括治疗疼痛、失眠和/或焦虑的替代策略。 通过使用 EHR，我们将能够提供以下方面的跌倒预防服务转介： 对有阿片类药物和 BZD 药物风险的老年人采用取消处方方案 瀑布。我们将能够纳入替代（和多学科）治疗方式和/或 必要时服用药物。这项研究将确定影响有效性的因素， 采用、实施和维护以 BZD 为重点的取消处方计划 阿片类药物，旨在减少跌倒。这将使我们能够制定开发指南 并为美国其他卫生系统实施类似的计划。