This is the second submission of a VA HSR&D CDA proposal to provide five years of salary support to Amy Linsky, MD, MSc toward her goal of developing into a VA independent investigator and expert on medication safety research. Dr. Linsky is a general internist and an investigator in the HSR&D Center for Organization, Leadership, and Management Research (COLMR) at VA Boston Healthcare System. This proposal delineates the research and training objectives that will lead to Dr. Linsky's maturation into an independent health services researcher while contributing to the fields of patient safety and quality of care, especially as thy pertain to appropriate medication use. The first proposed research objective will center on elucidating Veterans' and clinicians' perspectives on intentional medication discontinuation, a part of the prescribing process that to date has not been explored. Building on qualitative work in progress, Dr. Linsky will develop two survey instruments: one to elicit patients' attitudes and beliefs and the other to understand how clinicians view overmedication and potential medication discontinuation. Bringing the Veterans' preferences into clinical decision making is concordant with other efforts in the VA to promote patient-centered care. The VA is a vanguard of health information technology, with a well-established and integrated electronic health record. Despite this, medication discrepancies, with potential to cause serious harm to patients, persist. One type of discrepancy, therapeutic duplication, can lead to unintentional overdose. The second research objective proposes to identify the prevalence of this safety concern within VA nationally and to identify correlates of these duplications. To effect meaningful change in prescribing, the results of these first two research objectives will be combined with relevant findings in the literature to develop and pilot test an intervention intended to promote consideration of
Adverse outcomes from inappropriate medication use are pervasive, even within the VA. While significant attention is given to medication adherence and reconciliation, there has been less focus on improving intentional discontinuation of medications that may no longer be necessary or whose benefits no longer outweigh associated risks. Before we can implement a successful intervention to improve medication discontinuation processes, gaps in knowledge about the key participants, as well as other contributing clinical and organizational factors, need to be addressed. We will elucidate how Veterans and their health care providers feel about issues related to medication discontinuation. We will identify the prevalence and correlates of a high-risk medication discrepancy - therapeutic duplication - that may result from failure to discontinue medications. We will then develop and pilot test an intervention to improve prescribing in the VA, with an ultimate goal of reducing the use of medications that may no longer be necessary.
