Clinicians' Perspectives on Barriers and Enablers of Optimal Prescribing in Patients with Dementia and Coexisting Conditions
Clinicians' Perspectives on Barriers and Enablers of Optimal Prescribing in Patients with Dementia and Coexisting Conditions
复制标题
DOI：
10.3122/jabfm.2019.03.180335
复制
发表时间：
2019-05-01
影响因子：
2.9
通讯作者：
Boyd, Cynthia M.
中科院分区：
文献类型：
--
作者：
Green, Ariel R.;Lee, Patricia;Boyd, Cynthia M.
目的：痴呆症患者频繁服用多种药物、可能存在不当用药以及药物不良事件。对于临床医生如何优化针对这一人群的处方，几乎没有任何指导。我们的目标是调查临床医生认为优化痴呆症患者处方的障碍和促进因素。方法：定性研究，涉及对城市、郊区和农村地区的初级保健和专科临床医生的半结构化访谈。使用定性内容分析对成绩单进行分析。结果：对 12 名初级保健医生和 9 名专科临床医生进行了访谈，平均 (SD) 年龄为 47 (9) 岁，平均 (SD) 执业年龄为 14 (10) 岁。临床医生指出，有关以下药物类别的决定特别具有挑战性：口服抗凝剂、抗糖尿病药、他汀类药物、膀胱抗毒蕈碱药和抗精神病药。优化处方的被认为的推动因素包括获得跨学科服务和针对非痴呆疾病（例如糖尿病）的指南，以解决痴呆症患者的护理问题。障碍包括缺乏大多数药物对痴呆症患者的疗效和安全性数据，难以评估个体患者的药物效果，以及认为停止药物被视为“放弃”。临床医生使用各种策略与患者和护理人员讨论药物的风险和益处。结论：临床医生发现了优化痴呆症患者处方的许多障碍和一些促进因素。需要更多数据来了解该人群停止用药的益处和危害。研究还应该测试不同的方法，以支持痴呆症患者和护理人员做出明智的药物决策。
Purpose: Patients with dementia experience high rates of polypharmacy, potentially inappropriate medication use, and adverse drug events. There is little guidance for clinicians on how to optimize prescribing for this population. Our objective was to investigate clinician-perceived barriers to and facilitators of optimizing prescribing for people with dementia.Methods: Qualitative study involving semistructured interviews of primary care and specialist clinicians in urban, suburban, and rural settings. Transcripts were analyzed using qualitative content analysis.Results: Interviews were conducted with 12 primary care and 9 specialist clinicians, with a mean (SD) age of 47 (9) and mean (SD) of 14 (10) years in practice. Clinicians cited decisions regarding the following drug classes as particularly challenging: oral anticoagulants, antidiabetic agents, statins, bladder antimuscarinics, and antipsychotics. Perceived enablers of optimizing prescribing included access to interdisciplinary services and guidelines for nondementia illnesses (eg, diabetes) addressing the care of people with dementia. Barriers included the lack of data on efficacy and safety of most medications in people with dementia, difficulty assessing medication effects in an individual patient, and the perception that stopping medications is seen as "giving up." Clinicians used a variety of strategies to discuss risks and benefits of medications with patients and caregivers.Conclusions: Clinicians identified numerous barriers to and some facilitators of optimizing prescribing in people with dementia. More data are needed on the benefits and harms of stopping medications in this population. Research should also test different approaches for supporting informed decision making about medications by people with dementia and caregivers.