Deprescribing psychotropic medications in children: results of a national qualitative study
Deprescribing psychotropic medications in children: results of a national qualitative study
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DOI：
10.1136/bmjqs-2019-010033
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发表时间：
2020-08-01
影响因子：
5.4
通讯作者：
Leyenaar, Joanna K.
中科院分区：
文献类型：
--
作者：
Barnett, Erin R.;Trepman, Alissa Z.;Leyenaar, Joanna K.
背景与目的近年来，尽管很少有监管机构批准，而且对副作用的担忧日益增加，但儿童精神药物的处方数量急剧增加。政府的政策和许多方案正试图遏制这一问题。然而，实践临床医生的观点尚未被探索。描述儿科初级保健临床医生和精神卫生专家关于儿童精神药物过度开处方和减处方的观点和经验。方法：我们对代表美国不同地理区域和实践环境的临床医生进行了24次半结构化访谈。访谈问题集中在临床医生对过度处方的看法和处方减少的经验。我们逐字抄录音频文件并核实其准确性。我们使用扎根理论方法分析转录本，识别新兴主题并使用轴向编码开发概念模型。结果分析产生了四个领域的主题：社会和临床环境因素导致处方过量，处方减少的机会，以及儿科门诊处方减少的促进因素和障碍。大多数参与者都认识到过量处方的问题，他们描述了导致过量处方的复杂临床和社会背景因素，以及内部和外部压力。减少处方的机会包括确定高风险药物，对药物需求进行常规重新评估，并认识到弱势儿童更广泛的社会需求。对临床医生来说，处方化的促进因素和障碍既有内部因素（例如，向家庭提供心理教育），也有外部因素（例如，父母和儿童的偏好）。结论：我们的研究结果强调了临床医生对过度处方的担忧与门诊儿科缺乏支持处方的资源之间的差异。为了成功地开始开处方，临床医生将需要实用的工具和组织支持，以及弱势家庭的社会资源。
Background and Objective Prescriptions for psychotropic medications to children have risen dramatically in recent years despite few regulatory approvals and growing concerns about side effects. Government policy and numerous programmes are attempting to curb this problem. However, the perspectives of practising clinicians have not been explored. To characterise the perspectives and experiences of paediatric primary care clinicians and mental health specialists regarding overprescribing and deprescribing psychotropic medications in children. Methods We conducted 24 semistructured interviews with clinicians representing diverse geographic regions and practice settings in the USA. Interview questions focused on clinician perspectives surrounding overprescribing and experiences with deprescribing. We transcribed audio files verbatim and verified them for accuracy. We analysed transcripts using a grounded theory approach, identifying emergent themes and developing a conceptual model using axial coding. Results Analysis yielded themes within four domains: social and clinical contextual factors contributing to overprescribing, opportunities for deprescribing, and facilitators and barriers to deprescribing in paediatric outpatient settings. Most participants recognised the problem of overprescribing, and they described complex clinical and social contextual factors, as well as internal and external pressures, that contribute to overprescribing. Opportunities for deprescribing included identification of high-risk medications, routine reassessment of medication needs and recognition of the broader social needs of vulnerable children. Facilitators and barriers to deprescribing were both internal (eg, providing psychoeducation to families) and external (eg, parent and child preferences) to clinicians. Conclusion Our findings highlight a discrepancy between clinicians' concerns about overprescribing and a lack of resources to support deprescribing in outpatient paediatric settings. To successfully initiate deprescribing, clinicians will need practical tools and organisational supports, as well as social resources for vulnerable families.