Improving Geriatric Drug Safety in Underserved Practices

Adverse drug events (ADEs) are among the most common and serious medication use concerns
among older patients in primary care practices, yet they are often preventable. This
translational research into practice (TRIP) pilot study uses a randomized trial to evaluate
the effect of a site-level intervention in a sample of practices in medically underserved
communities within the Upstate New York Practice Based Research Network (UNYNET). These
sites are located in rural and urban areas and include an over-sample of minority patients.
The specific aims of this study are to:

1. Examine the feasibility of objectively assessing the impact of a CRM (adapted Crew
Resource Management approach proven successful in aviation as well as some inpatient
medical settings) intervention on reducing medication errors among geriatric patients
in primary care settings; and

2. Assess office staff internalization and application of CRM principles for reducing
geriatric medication errors in primary care settings by examining changes in safety
attitude constructs achieved

1. with a practice enhancement assistant (PEA) and

2. without a PEA.

Outcomes measured for Aim #1 will be change in number, severity, consequence, and stage of
process of preventable ADEs. Outcomes for Aim # 2 will be change in safety climate, teamwork
climate, stress recognition, and working conditions.

Fifteen sites will be randomized into one of three intervention arms: usual care, CRM only,
or CRM plus a PEA. A random sample of charts of older adults (aged >64) with cardiovascular
disease will be reviewed for adverse drug events over prior-year periods at baseline and
post-intervention endpoints. Participatory research methods will be used to assess provider-
and staff-identified barriers to implementation. This study will test the feasibility of
incorporating PEA's into the practice setting to improve geriatric medication safety. The
information gathered will serve as a basis for an ongoing translational research program
that will lead to an RO1 application.

Practice Inclusion Criteria:

- Practice must located in Health Professional Shortage Area or Physician Scarcity
Area.

- Practice must be a member of the Western New York Practice-Based Research Network

Practice Exclusion Criteria:

Patient Inclusion Criteria (for chart review):

- Aged >64

- Cardiovascular disease

- Seen at the practice within the past year

Patient Exclusion Criteria (for chart review):