Deprescribing medications that may increase the risk of hepatic encephalopathy: A qualitative study of patients with cirrhosis and their doctors.
Deprescribing medications that may increase the risk of hepatic encephalopathy: A qualitative study of patients with cirrhosis and their doctors.
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对可能增加肝性脑病风险的药物进行划分的药物：肝硬化患者及其医生的定性研究。
DOI：
10.1177/2050640620975224
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发表时间：
2021-03
影响因子：
6
通讯作者：
Tapper EB
中科院分区：
文献类型：
--
作者：
Williams S;Louissaint J;Nikirk S;Bajaj JS;Tapper EB
多种药物与肝性脑病发病风险增加有关。尽管存在这种已知风险，但阿片类药物、苯二氮䓬类药物、加巴喷丁/普瑞巴林和/或质子泵抑制剂等药物越来越多地开给肝硬化患者。减药是一种有前景的干预措施，可减轻肝性脑病的负担。鉴于减药尚未在肝硬化中进行试验，我们评估了在肝硬化中安全且成功减药的障碍和促进因素。
我们使用定性方法对22名受试者进行了半结构化访谈，并对访谈内容进行了转录和分析。其中包括8名肝硬化患者，他们近期使用过阿片类药物、苯二氮䓬类药物、加巴喷丁/普瑞巴林和/或质子泵抑制剂，以及14名医疗服务提供者（初级保健医生、移植外科医生、移植肝病医生）。访谈探讨了围绕减药的风险和益处的观点、行为和理解。
医疗服务提供者方面的主要障碍包括减药过程中的责任推诿、对与药物（如质子泵抑制剂）相关的肝性脑病风险以及安全减药方法（如苯二氮䓬类药物）的知识欠缺，以及时间限制。患者方面的障碍包括对其药物在肝硬化方面的特定风险缺乏了解，以及对停药后症状复发的焦虑。患者一致表示信任医生对风险的看法，并希望在就诊期间或之后能接受更全面的教育。医疗服务提供者一致表示支持减药资源，包括药剂师或护士的外联服务。
鉴于已知肝硬化患者中与肝性脑病相关的药物风险，减药普遍被视为重要措施。知识欠缺、不作为以及对可行替代方案的不确定性阻碍了减药的有效实施。有必要进行基于药房的规范化减药外联试验以及面向患者的风险教育。
**总结关于该主题的已有知识**
- 肝性脑病（HE）是肝硬化的一种严重并发症。
- 精神活性药物和质子泵抑制剂可能会增加肝性脑病的风险。
- 减药被认为是预防肝性脑病的一种有前景的方法。
**本研究的重要和/或新发现是什么？**
- 患者不知道他们所服用的药物如何影响肝性脑病的风险。
- 患者愿意遵循医生关于减药的建议，但害怕症状恶化。
- 医生对减用阿片类药物或苯二氮䓬类药物感到不自在。
- 医生不觉得有责任进行减药，也不具备相关资源。
Multiple medications are associated with an increased risk of incident hepatic encephalopathy. Despite this known risk, medications such as opioids, benzodiazepines, gabapentin/pregabalin, and/or proton pump inhibitors are increasingly prescribed to persons with cirrhosis. Deprescribing is a promising intervention to reduce the burden of hepatic encephalopathy. Given that deprescribing has not been trialed in cirrhosis, we evaluated the barriers and facilitators to safe and successful deprescribing in cirrhosis. We conducted, transcribed, and analyzed semi‐structured interviews using qualitative methodology with 22 subjects. This included eight patients with cirrhosis and recent use of opiates, benzodiazepines, gabapentin/Lyrica, and/or proton pump inhibitors as well as 14 providers (primary care, transplant surgery, transplant hepatology). Interviews explored opinions, behaviors, and understanding surrounding the risks and benefits of deprescribing. Major provider‐specific barriers included deferred responsibility of the deprescribing process, knowledge gaps regarding the risk of hepatic encephalopathy associated with medications (e.g., proton pump inhibitors) as well as the safe method of deprescription (i.e., benzodiazepines), and time constraints. Patient‐specific barriers included knowledge gaps regarding the cirrhosis‐specific risks of their medications and anxiety about the recurrence of symptoms after medication discontinuation. Patients uniformly reported trust in their provider's opinions on risks and wished for more comprehensive education during or after visits. Providers uniformly reported support for deprescription resources including pharmacist or nurse outreach. Given knowledge of medication risks related to hepatic encephalopathy in patients with cirrhosis, deprescribing is universally seen as important. Knowledge gaps, inaction, and uncertainty regarding feasible alternatives prevent meaningful implementation of deprescription. Trials of protocolized pharmacy‐based deprescribing outreach and patient‐facing education on risks are warranted. Summarize the established knowledge on this subject Hepatic encephalopathy (HE) is a morbid complication of cirrhosis. The risk of HE may be increased by psychoactive medications and proton pump inhibitors. Deprescribing is felt to be a promising approach to HE prevention. What are the significant and/or new findings of this study? Patients are unaware of how their medications influence the risk of HE. Patients are willing to follow physician recommendations regarding deprescribing but are afraid of worsening symptoms. Physicians do not feel comfortable deprescribing opioids or benzodiazepines. Physicians do not feel responsible or equipped with the resources for deprescribing.
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影响因子：
3.8
作者：
Anderson, Eileen S.;Winett, Richard A.;Wojcik, Janet R.
通讯作者：
Wojcik, Janet R.
DOI：
10.1111/j.1365-2710.1995.tb00649.x
发表时间：
1995-08-01
影响因子：
2
作者：
BRITTEN, N;BRANT, S;HERXHEIMER, A
通讯作者：
HERXHEIMER, A
影响因子：
39
作者：
Reeve, Emily;Wolff, Jennifer L.;Boyd, Cynthia M.
通讯作者：
Boyd, Cynthia M.
影响因子：
12.6
作者：
Ghabril, Marwan;Jackson, Mollie;Chalasani, Naga
通讯作者：
Chalasani, Naga
影响因子：
13.5
作者：
GINES, P;QUINTERO, E;ROZMAN, C
通讯作者：
ROZMAN, C