Doctors' perspectives on the barriers to appropriate prescribing in older hospitalized patients: a qualitative study
Doctors' perspectives on the barriers to appropriate prescribing in older hospitalized patients: a qualitative study
复制标题
DOI：
10.1111/bcp.12555
复制
发表时间：
2015-05-01
影响因子：
3.4
通讯作者：
Byrne, Stephen
中科院分区：
文献类型：
--
作者：
Cullinan, Shane;Fleming, Aoife;Byrne, Stephen
老年患者通常患有多轨道症，并服用多种药物。因此，这些患者更容易受到潜在不适当处方（PIP）的影响。老年患者的PIP可能导致药物不良事件（ADE）和住院治疗。然而，很少有人知道PIP发生的原因。本研究的目的是（一）确定医院医生的看法，为什么PIP发生，（二）确定的障碍，以解决所确定的问题和（三），以确定哪些干预类型将是最适合改善prescribing.MethodsSemi-structured访谈的基础上的理论领域框架（TDF），一种工具，用于应用行为改变理论，进行了22医院医生。进行内容分析，以确定TDF的领域，可以有针对性地改善老年人的处方。这些领域，然后映射到行为改变轮，以确定可能的干预types.ResultsContent分析确定了5个相关的12个域中的TDF：（一）环境背景和资源，（二）知识，（三）技能，（四）社会影响和（五）记忆/注意力和决策过程。使用的行为改变车轮，被认为是合适的干预措施的类型是那些基于培训和环境restructuring.ConclusionThis研究表明，医生觉得有足够的重视老年药物治疗在他们的本科/研究生培训。提供补充培训，特别强调决策过程和处理社会影响的干预措施是合理的。然而，这项研究发现了许多未来可能采取干预措施的领域。
AimsOlder patients commonly suffer from multimorbidites and take multiple medications. As a result, these patients are more vulnerable to potentially inappropriate prescribing (PIP). PIP in older patients may result in adverse drug events (ADEs) and hospitalizations. However, little has been done to identify why PIP occurs. The objectives of this study were (i) to identify hospital doctors' perceptions as to why PIP occurs, (ii) to identify the barriers to addressing the issues identified and (iii) to determine which intervention types would be best suited to improving prescribing.MethodsSemi-structured interviews based on the Theoretical Domains Framework (TDF), a tool used to apply behaviour change theories, were conducted with 22 hospital doctors. Content analysis was conducted to identify domains of the TDF that could be targeted to improve prescribing for older people. These domains were then mapped to the behaviour change wheel to identify possible intervention types.ResultsContent analysis identified five of the 12 domains in the TDF as relevant: (i) environmental context and resources, (ii) knowledge, (iii) skills, (iv) social influences and (v) memory/attention and decision processes. Using the behaviour change wheel, the types of interventions deemed suitable were those based on training and environmental restructuring.ConclusionThis study shows that doctors feel there is insufficient emphasis on geriatric pharmacotherapy in their undergraduate/postgraduate training. An intervention providing supplementary training, with particular emphasis on decision processes and dealing with social influences would be justified. This study has, however, uncovered many areas for potential intervention in the future.