Prescriber perspectives on low-value prescribing: A qualitative study.
Prescriber perspectives on low-value prescribing: A qualitative study.
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DOI：
10.1111/jgs.17099
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发表时间：
2021-06
影响因子：
6.3
通讯作者：
Radomski TR
中科院分区：
文献类型：
--
作者：
Walter EL;Dawdani A;Decker A;Hamm ME;Pickering AN;Hanlon JT;Thorpe CT;Roberts MS;Fine MJ;Gellad WF;Radomski TR
卫生系统正在越来越多地实施干预措施，以减少老年患者使用低价值药物。然而，处方者对药物价值的看法以及减少低价值处方的干预措施的可接受性却知之甚少。从初级保健医生的角度，确定影响药物价值的特征和影响低价值处方的因素。定性研究采用半结构化访谈。匹兹堡大学医学中心卫生系统内的学术和社区初级保健实践。16名初级保健医生。我们就老年人低价值处方的定义和例子、激励他们参与此类处方的因素以及使他们不太可能参与低价值处方的干预措施的特点，征求了16名处方者的观点。我们确定了三个关键主题。首先，处方者认为在老年人中开低价值的处方是常见的，既有药物本身的特点，也有给他们开药的特定患者的特点。其次，处方人员将低价值处方的原因描述为多因素的，涉及患者、处方人员和整个医疗系统的因素，使低价值处方成为默认的实践模式。第三，针对低价值处方的干预措施必须将使低价值处方普遍存在的认知负荷和时间压力降至最低。增加时间压力或认知负荷的干预措施，如增加文件，被认为是不能接受的。我们的研究结果表明，低价值处方是一种公认的现象，减少低价值处方的干预措施必须考虑医生的观点，并解决使低价值处方成为默认做法的特定患者、处方者和卫生系统因素。
Health systems are increasingly implementing interventions to reduce older patients’ use of low-value medications. However, prescribers’ perspectives on medication value and the acceptability of interventions to reduce low-value prescribing are poorly understood. To identify the characteristics that affect the value of a medication and those factors influencing low-value prescribing from the perspective of primary care physicians. Qualitative study using semi-structured interviews. Academic and community primary care practices within University of Pittsburgh Medical Center health system. Sixteen primary care physicians. We elicited 16 prescribers’ perspectives on definitions and examples of low-value prescribing in older adults, the factors that incentivize them to engage in such prescribing, and the characteristics of interventions that would make them less likely to engage in low-value prescribing. We identified three key themes. First, prescribers viewed low-value prescribing among older adults as common, characterized both by features of the medications themselves and of the particular patients to whom they were prescribed. Second, prescribers described the causes of low-value prescribing as multifactorial, with factors related to patients, prescribers, and the health system as a whole, making low-value prescribing a default practice pattern. Third, interventions addressing low-value prescribing must minimize the cognitive load and time pressures that make low-value prescribing common. Interventions increasing time pressure or cognitive load, such as increased documentation, were considered less acceptable. Our findings demonstrate that low-value prescribing is a well-recognized phenomenon, and that interventions to reduce low-value prescribing must consider physicians’ perspectives and address the specific patient, prescriber and health system factors that make low-value prescribing a default practice.
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影响因子：
6.3
作者：
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通讯作者：
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影响因子：
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影响因子：
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影响因子：
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作者：
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通讯作者：
Radomski, Thomas R.
影响因子：
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作者：
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