Helping patients simplify and safely use complex prescription regimens.
Helping patients simplify and safely use complex prescription regimens.
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DOI：
10.1001/archinternmed.2011.39
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发表时间：
2011-02-28
影响因子：
--
通讯作者：
Wood, Alastair J. J.
中科院分区：
文献类型：
--
作者：
Wolf, Michael S.;Curtis, Laura M.;Waite, Katherine;Bailey, Stacy Cooper;Hedlund, Laurie A.;Davis, Terry C.;Shrank, William H.;Parker, Ruth M.;Wood, Alastair J. J.
医生书写处方和药剂师抄录处方的方式存在相当大的差异，导致患者对标签说明的误解。最近提出了一种“通用药物时间表”（UMS），用于将处方实践标准化为每天四个时间间隔，从而帮助患者简化和安全地使用药物。我们调查了患者是否合并药物治疗，或者是否有证据表明存在不必要的方案复杂性，从而支持标准化。对464名年龄在55-74岁之间的成年人进行了结构化访谈，他们在伊利诺斯州芝加哥的一家学术全科医学诊所或三家联邦合格的健康中心接受治疗。受试者被给予一个假设的七种药物的药物治疗方案，并被要求证明他们将如何以及何时在24小时内服用所有药物。该方案可合并为每天4次给药。主要结果是每天服药的次数。检查了使方案复杂化的患者的根本原因（>每天四次）。参与者平均在24小时内确定6次服用7种药物（SD=1.8;范围3至14）。三分之一（29.3%）的人每天服药七次或更多次，而只有14.9%的人每天服药四次或更少。在多变量分析中，识字率低是每天停止给药次数更多的独立预测因素（β=0.67; 95%置信区间0.12 - 1.22，p=0.018）。其中两种药物的说明书是相同的，但31%的患者没有同时服用这些药物。另一组药物也有类似的说明，但有一种药物添加了“与食物和水一起服用”的说明。一半（49.5%）的参与者在不同时间服用这些药物。当药物对相同的给药频率有不同的表达时（“每12小时”与“每天两次”），79.0%的药物没有合并。许多患者，特别是识字能力有限的患者，没有以最有效的方式巩固处方方案，这可能会妨碍依从性。UMS和其他以任务为中心的策略提出的标准化说明可能有助于患者常规组织和服用药物方案。
There is considerable variability in the manner in which prescriptions are written by physicians and transcribed by pharmacists, resulting in patient misunderstanding of label instructions. A ‘universal medication schedule’ (UMS) was recently proposed for standardizing prescribing practices to four daily time intervals thereby helping patients simplify and safely use their medicine. We investigated whether patients consolidate their medications, or if there is evidence of unnecessary regimen complexity that would support standardization. Structured interviews were conducted with 464 adults ages 55–74 who were receiving care at either an academic general medicine practice or one of three federally qualified health centers in Chicago, Illinois. Subjects were given a hypothetical, seven-drug medication regimen and asked to demonstrate how and when they would take all of the medicine in a 24-hour period. The regimen could be consolidated into four dosing episodes per day. The primary outcome was the number of times per day individuals would take medicine. Root causes for patients complicating the regimen (> four times a day) were examined. Participants on average identified six times in 24 hours to take the seven drugs (SD=1.8; range 3 to 14). One third (29.3%) found seven or more times per day to take their medicine, while only 14.9% organized the regimen into four or fewer times a day. In multivariable analysis, low literacy was an independent predictor of more times per day for dosing out the regimen (β=0.67; 95% Confidence Interval 0.12 to 1.22, p=0.018). Instructions for two of the drugs were identical, yet 31% of patients did not dose these medicines at the same time. Another set of drugs had similar instructions with the primary exception of one having the added instruction to take “with food and water”. Half (49.5%) of participants dosed these medicines at different times. When medicines had variable expressions of the same dose frequency (“every 12 hours” vs. “twice daily”), 79.0% did not consolidate the medicines. Many patients, especially those with limited literacy, do not consolidate prescription regimens in the most efficient manner, which could impede adherence. Standardized instructions proposed with the UMS and other task-centered strategies could potentially help patients routinely organize and take medication regimens.
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影响因子：
2.7
作者：
Wolf, Michael S.;Davis, Terry C.;Parker, Ruth M.
通讯作者：
Parker, Ruth M.
影响因子：
--
作者：
Shrank, William H.;Agnew-Blais, Jessica;Shekelle, Paul
通讯作者：
Shekelle, Paul
影响因子：
2.2
作者：
Shrank, William H.;Parker, Ruth;Wolf, Michael S.
通讯作者：
Wolf, Michael S.
影响因子：
4.4
作者：
Weiss, BD;Mays, MZ;Hale, FA
通讯作者：
Hale, FA
影响因子：
4.2
作者：
Salthouse, Timothy A.
通讯作者：
Salthouse, Timothy A.