(Applicant s abstract) Sally K. Rigler, MD, is an academic geriatrician whose clinical experience in long-term care (LTC) led to a strong research interest in prescribing patterns for nursing facility residents. This proposal provides support for formal coursework and implementation of two mentored research projects using quantitative and qualitative methods to address the prescribing of inappropriate benzodiazepine and sedative-hypnotics (Benz/Sed) medications in nursing facilities, with particular focus on potential urban-rural differences. Two interrelated perspectives will ground this work: 1 ) examination of large-scale prescribing trends from 1992-98, using the Kansas Minimum Data Set (MDS), of Benz/Sed drugs; and 2) qualitative evaluation of prescribers beliefs about what factors are influential in LTC when making prescribing decisions regarding these medications. Both approaches will examine urban-rural differences. Career Development Plan: The candidate will undertake coursework in quantitative and qualitative methods, along with research conferences, junior faculty writers? group meetings, and other formal mentoring activities under the primary Sponsorship of Dr. Stephanie Studenski, Director of the Center on Aging, University of Kansas Medical Center. Research Program: a) Quantitative Project (emphasized Years 1 - 2): The applicant?s previous experience with Kansas MDS data is outlined in the proposal; she is aware of its limitations and opportunities. She will investigate use of Benz/Sed medications in Kansas nursing home residents, with special emphasis on those deemed inappropriate for older adults. Urban-rural and time effects will be examined; the 1992-98 data provide information about prescribing patterns prior to recent regulatory changes in the nursing home survey process. Dr. A. Kramer, a senior-level investigator with expertise in secondary data, will serve as Co-sponsor for the quantitative project. b) Qualitative Project (emphasized Years 3 - 5): The candidate will gain new research skills in qualitative methods under the guidance of Dr. D. Stull, Professor of Anthropology, Univ. of Kansas, Lawrence campus. The initial qualitative work will use prescriber focus groups and interviews of consultant pharmacists and directors of nursing, to broadly capture themes about what factors influence prescribing decisions in LTC, emphasizing decisions about Benz/Sed drugs. Potential urban-rural differences will be examined. Further detailed interviews with physician and nurse practitioner prescribers will take place, using insights gained during initial focus groups. Finally, a survey tool will be developed based on these results, followed by modification and validation in preparation for a future broader survey of LTC prescribers. The candidate's goal is to become an independent investigator in the area of prescribing influences in LTC, for the ultimate purpose of developing, implementing, and evaluating targeted interventions to improve prescribing for nursing facility residents.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Clinical Investigator Award (CIA) (K08)
Project #
5K08AG019516-02
Application #
6532565
Study Section
National Institute on Aging Initial Review Group (NIA)
Program Officer
Stahl, Sidney M
Project Start
2001-09-15
Project End
2006-08-31
Budget Start
2002-09-01
Budget End
2003-08-31
Support Year
2
Fiscal Year
2002
Total Cost
$120,537
Indirect Cost
Name
University of Kansas
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
016060860
City
Kansas City
State
KS
Country
United States
Zip Code
66160
Rigler, Sally K; Shireman, Theresa I; Kallenbach, Lynne (2007) Predictors of long-acting opioid use and oral versus transdermal route among older Medicaid beneficiaries. Am J Geriatr Pharmacother 5:91-9
Shireman, Theresa I; Hall, Jean P; Rigler, Sally K et al. (2007) Medicaid's expenditures for newer pharmacotherapies for adults with disabilities. Health Care Financ Rev 28:31-41
Shireman, Theresa I; Rigler, Sally K (2006) Predictors of the selection of coxibs over nonselective NSAIDs in an older Medicaid cohort. Am J Geriatr Pharmacother 4:210-8
Rigler, Sally K; Jachna, Carolyn M; Perera, Subashan et al. (2005) Patterns of potentially inappropriate medication use across three cohorts of older Medicaid recipients. Ann Pharmacother 39:1175-81
Shireman, Theresa I; Rigler, Sally K; Jachna, Carolyn M et al. (2005) The cost effect of newer medication adoption in an older Medicaid cohort. J Am Geriatr Soc 53:1366-73
Rigler, Sally K; Perera, Subashan; Jachna, Carolyn et al. (2004) Comparison of the association between disease burden and inappropriate medication use across three cohorts of older adults. Am J Geriatr Pharmacother 2:239-47