Prescribing cascades in persons with Alzheimer's disease: engaging patients, caregivers, and providers in a qualitative evaluation of print educational materials.
Prescribing cascades in persons with Alzheimer's disease: engaging patients, caregivers, and providers in a qualitative evaluation of print educational materials.
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DOI：
10.1177/2042098620968310
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发表时间：
2020
影响因子：
4.4
通讯作者：
Mazor KM
中科院分区：
文献类型：
--
作者：
Bloomstone S;Anzuoni K;Cocoros N;Gurwitz JH;Haynes K;Nair VP;Platt R;Rochon PA;Singh S;Mazor KM
当一种药物的副作用被误解为一种新的医疗状况时，就会发生处方级联，并开出第二种药物来解决副作用。阿尔茨海默氏病（AD）患者由于更大的多发病率，多种药物和护理复杂性而面临处方级联的风险增加。本研究的目的是评估有关AD患者处方级联的教育材料，并在未来的试验中对其使用进行输入。我们采访了患有AD诊断或用于治疗AD的处方药的社区居住成年人（n = 12），符合相同标准的患者的照顾者（n = 14）和提供者（n = 15）。我们编码的采访成绩单和组织的主题根据通信人类信息处理模型。我们根据访谈修改了材料，并调查了参与的照顾者和提供者对修改后的材料的反应。对患者、患者和提供者意见的分析表明：（a）提供者对材料的信息传递有相互矛盾的看法;（B）护理人员可能会阅读写给患者的信件;（c）提供者可能会忽略信件，但接受患者/护理人员发起的对话;（d）患者和护理人员难以理解处方级联;（e）提供者担心邮寄的材料会破坏信任;（f）参与者对材料如何影响临床接触的看法不一;（g）参与者认为材料会改善患者/护理人员的参与。在接受调查时，大多数提供者认为修订后的材料信息丰富，可操作，大多数护理人员认为它们可以理解和有用。对AD患者处方级联相关教育材料的评价为护理人员与供应商就处方级联进行沟通提供了强有力的支持。通过向患者和护理人员提供处方级联概念的基本描述，我们的教育材料可以帮助他们准备与提供者的对话，然后提供者可以根据患者和护理人员的具体需求定制可能的级联讨论。然而，关于材料是否能刺激这种对话的证据还有待于未来的试验。 患者、护理人员和提供者对有关处方和药物安全的教育材料的看法当药物的副作用被误解为新的医疗状况时，会发生处方级联，并开出第二种药物来治疗副作用。阿尔茨海默病（AD）患者开级联处方的风险增加，因为他们通常有更多的医疗条件，更多的药物和更复杂的护理。本研究的目的是评估邮寄的教育材料与AD患者的处方级联，并在未来的研究中使用它们的输入。我们采访了12名成人AD患者，或处方药物治疗AD，14名AD患者的护理人员和15名提供者。我们回顾了访谈记录，以确定有关我们的教育材料的重要发现。我们根据访谈编辑了材料，并向参与的护理人员和提供者发送了一份问卷，以了解他们对新材料的反应。访谈的重要结果表明：（a）提供者对所提建议的看法相互矛盾;（B）护理人员可能会阅读给病人的信件;（c）提供者可能会忽略信件，但愿意接受病人/护理人员介绍这一主题;（d）病人和护理人员难以理解处方级联;（e）提供者担心邮寄材料会破坏信任;（f）与会者对材料如何影响医生预约的看法不一;（g）与会者强烈认为，材料将改善病人/护理人员的参与。在接受调查时，几乎所有的提供者都认为修订后的材料内容丰富，可操作;大多数护理人员认为它们可以理解和有用。这些研究结果提供了强有力的支持，从事照顾者与供应商沟通有关处方级联。教育材料可以帮助患者和护理人员准备与提供者的对话，然后提供者可以根据患者和护理人员的具体需求定制可能级联的讨论。然而，关于材料是否能刺激这种对话的证据还有待于未来的研究进行测试。
Prescribing cascades occur when the side effect of a drug is misinterpreted as a new medical condition, and a second drug is prescribed to address the side effect. Persons with Alzheimer’s disease (AD) are at increased risk of prescribing cascades due to greater multimorbidity, polypharmacy, and complexity of care. The objective of this study was to evaluate educational materials about prescribing cascades in persons with AD, and elicit input on their use in a future trial. We interviewed community-dwelling adults with either an AD diagnosis or a prescription drug used to treat AD (n = 12), caregivers of patients meeting the same criteria (n = 14), and providers (n = 15). We coded interview transcripts and organized themes according to the communication–human information processing model. We revised the materials based on the interviews, and surveyed participating caregivers and providers for their reactions to the revised materials. Analysis of patients’, caregivers’, and providers’ comments suggest: (a) Providers had conflicting views about the messaging of materials; (b) Caregivers were likely to read letters addressed to patients; (c) Providers were likely to ignore letters, but were receptive to patient/caregiver-initiated conversations; (d) Patients and caregivers had difficulty understanding prescribing cascades; (e) Providers worried that mailed materials would undermine trust; (f) Participants had mixed views on how materials might affect the clinical encounter; (g) Participants felt that materials would improve patient/caregiver engagement. When surveyed, most providers found the revised materials informative and actionable, and most caregivers found them understandable and useful. This evaluation of educational materials about prescribing cascades in patients with AD provides strong support for engaging caregivers to communicate with providers about prescribing cascades. By giving patients and caregivers a basic description of the prescribing cascade concept, our educational materials may help them prepare for a conversation with the provider, who can then tailor the discussion of the possible cascade to the specific needs of the individual patient and caregiver. However, evidence on whether materials can stimulate such conversations awaits testing in a future trial. Patient, caregiver and provider thoughts on educational materials about prescribing and medication safety Prescribing cascades occur when the side effect of a medication is misinterpreted as a new medical condition, and a second medication is prescribed to treat the side effect. Persons with Alzheimer’s disease (AD) are at increased risk of prescribing cascades because they often have more medical conditions, more medications, and more complex care. The goal of this study was to evaluate mailed educational materials about prescribing cascades in persons with AD, and get input on their use in a future study. We interviewed 12 adults with AD, or prescribed a medication to treat AD, 14 caregivers of persons with AD, and 15 providers. We reviewed the interview transcripts to identify important findings about our educational materials. We edited the materials based on the interviews, and sent participating caregivers and providers a questionnaire to get their reactions to the new materials. Important findings from the interviews suggest: (a) Providers had conflicting views about the recommendations given; (b) Caregivers were likely to read letters addressed to patients; (c) Providers were likely to ignore letters, but were receptive to patients/caregivers introducing the topic; (d) Patients and caregivers had difficulty understanding prescribing cascades; (e) Providers worried mailed materials would undermine trust; (f) Participants had mixed views on how materials might affect a doctor’s appointment; (g) Participants felt strongly that materials would improve patient/caregiver engagement. When surveyed, almost all providers found the revised materials informative and actionable; and most caregivers found them understandable and useful. These findings provide strong support for engaging caregivers to communicate with providers about prescribing cascades. The educational materials may help patients and caregivers prepare for a conversation with the provider, who can then tailor the discussion of the possible cascade to the specific needs of the individual patient and caregiver. However, evidence on whether materials can stimulate such conversations awaits testing in a future study.
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