Engaging Older Adults and Caregivers in Medication Optimization Research

Background: Older adults tend to use more medications at greater intensity and are at increased risk for poorly optimized medication therapies and, in some cases, the wrong doses or the wrong medications. Medical evidence suggests that novel approaches to improve medication use such as de-prescribing and pharmacist-led medication reviews offer improved medication use outcomes. And while comparative clinical effectiveness research (CER) is being conducted on these approaches to improve medication therapy for older adults, an older adult-centered approach that engages the person, family, and caregivers has not yet been undertaken.

 

Proposed Solution to the Problem: To enable patient-centered outcomes research (PCOR) on novel approaches to optimizing medication therapy, this project proposes to establish a geographically and demographically diverse set of collaborating centers, located in Hawaii, the Midwest, and Mid-Atlantic regions. While a global approach to training will be co-developed, implementation will be tailored to the unique needs of the communities in each of the regions. The culmination of this project will be the creation of a sustainable, diverse Age-Friendly Medication Optimization Network.

Objectives: The list of objectives begins with creating a community council to guide the project and co-develop the Age-Friendly Medication Optimization Network. PCOR training will be based on a needs assessment and delivered to 120 older adults, families and caregivers, pharmacists, and researchers. Training will be followed by participation opportunities in PCOR activities that simulate the early stages of continuous patient engagement to solicit and prioritize  research questions. 

 

Activities: During the two-year grant period, the project team will build the capacity of the network to engage in high-quality PCOR. The activities include creating an environment for all members of the community council to engage. Periodic assessments, both formal and informal, will ensure modification, as necessary. This council will develop questions and an approach to assessing the needs of their larger communities to engage in PCOR. A training agenda, curriculum, and evaluation will be designed and delivered with the implementation plan specific to the regional community. The council will determine how to facilitate participation in PCOR opportunities with a small team of researchers, older adults, family, caregivers, and pharmacists. These PCOR opportunities will involve identifying and prioritizing medication-related research questions that matter.

 

Projected Outcomes and Outputs: The projected outcomes include a successful community council,  the development of an Age-Friendly Medication Optimization Network with stakeholder groups having gained comfort with participating in PCOR. Ultimately, the outputs will be a training plan with agenda, curriculum, and implementation based on a needs assessment. In addition, lists of prioritized medication-related research questions will be provided.

 

Patient and Stakeholder Engagement Plan: Older adults, family members, caregivers, researchers, and pharmacists will meet every other month through the community council and quarterly through the regional networks. The community council will meet live virtually and be involved in asynchronous activities. Each regional site of the network has developed its own, population-specific plan for patient and stakeholder engagement. The Hawaii region will draw on existing relationships with healthcare and community partners who have advocated on issues of rural access to health care. The Midwest region will partner with community and faith-based organizations, building on relationships from Project Patient Care, which will spearhead the Midwest network. The Mid-Atlantic region will build on longstanding collaborations with senior housing sites, and other groups focused on safe medication practices, health literacy, and age-friendly approaches to research and health care. The participants in the regional networks will be engaged through live in-person, virtual, and/or asynchronous activities.

 

Project Collaborators: The regional partners will be the University of Hawaii, Hilo, Project Patient Care, and the University of Minnesota led by the Peter Lamy Center on Drug Therapy and Aging at the University of Maryland, Baltimore.