(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.
