title: Improving over-the-counter medication safety for older adults: A study protocol for a demonstration and dissemination study.
abstract: Adverse drug events (ADEs) associated with over-the-counter (OTC) medications cause 178,000 hospitalizations each year. Older adults, aged 65 and older, are particularly vulnerable to ADEs. Of the 2.2 million older adults considered at risk for a major ADE, more than 50% are at risk due to concurrent use of an OTC and prescription medication.
  
  
  
  To refine the intervention and implementation strategy through diagnostic and formative evaluation; to evaluate the effectiveness of the intervention for preventing misuse of high-risk OTC medications by older adults; and to evaluate the implementation of the intervention in community pharmacies.
  
  
  
  A system redesign intervention to decrease high-risk OTC medication misuse will be tested to reduce misuse by improving communication between older adults and community pharmacists via the following features: a redesign of the physical environment to sensitize older adults to high-risk OTC medications, and the implementation of a clinical decision tool to support the pharmacist when critically evaluating the older adult's health status. The study will be conducted in three phases: a participatory design phase, a beta phase, and a test phase. The test phase will be conducted in three mass-merchandise stores. A total of 144 older adults will be recruited. A pre (control)/post (intervention) test will determine the effectiveness of the intervention. The primary outcome will be a comparison of proportion of older adults who misuse OTC medication from baseline to post-intervention. The process of implementation in the community pharmacy setting will be evaluated using the taxonomy proposed by Proctor et al. The participatory design phase has been approved by the institution's IRB (2016-0743).
  
  
  
  It is anticipated that this project, which focuses on achieving systems-based improvement in an underemphasized area of the medication use process, will reduce ADEs associated with inappropriate OTC medication use in older adults.
authors.affiliation: Systems Approach to Medication Safety Research Laboratory, Social & Administrative Sciences Division, University of Wisconsin - Madison, School of Pharmacy, 777 Highland Avenue, Madison, WI, 53705, United States. Electronic address: michelle.chui@wisc.edu.
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Chui
authors.affiliation: Systems Approach to Medication Safety Research Laboratory, Social & Administrative Sciences Division, University of Wisconsin - Madison, School of Pharmacy, 777 Highland Avenue, Madison, WI, 53705, United States. Electronic address: jamie.stone@wisc.edu.
authors.forename: Jamie A
authors.initials: JA
authors.lastname: Stone
authors.affiliation: School of Informatics and Computing, Indiana University-Purdue University Indianapolis, 535 W. Michigan Street, IT 475, Indianapolis, IN, 46202, United States. Electronic address: rjholden@iupui.edu.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Holden
mesh_terms: D000368:Aged; D002985:Clinical Protocols; D003142:Communication; D004347:Drug Interactions; D000076064:Drug Misuse; D064420:Drug-Related Side Effects and Adverse Reactions / Q000517:prevention & control*; D006801:Humans; D004366:Nonprescription Drugs / Q000009:adverse effects; D061214:Patient Safety; D010594:Pharmacies; D010595:Pharmacists; D011369:Professional-Patient Relations
chemical_list: D004366:Nonprescription Drugs
keywords: Community pharmacy; Dissemination and implementation; Hybrid design; Medication safety; Older adults