Patient-reported medication symptoms in primary care.
Patient-reported medication symptoms in primary care.
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DOI：
10.1001/archinte.165.2.234
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发表时间：
2005-01-24
影响因子：
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通讯作者：
Bates, DW
中科院分区：
文献类型：
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作者：
Weingart, SN;Gandhi, TK;Bates, DW
背景：初级保健中药物相关症状的发生率和特征及其与药物不良事件(ADE)的关系以及影响医患沟通的因素知之甚少。方法：研究包括661名患者，他们在4个成人初级保健诊所接受医生的处方。我们在指数访问后2周和3个月采访了患者，回顾了患者的医疗记录，并调查了患者发现与药物有关的症状的医生。医生审查员确定药物症状是否构成真正的ADE。我们使用多变量回归分析患者决定与医生讨论症状和医生决定改变治疗的相关因素。结果：共有179名患者确定了286个与药物相关的症状，但只与医生讨论了196个(69%)。医生根据76%的报告症状改变了治疗方法。患者没有讨论90种药物症状，导致19例(21%)可改善和2例(2%)可预防的不良反应。48例内科医生治疗失败导致31例(65%)ADE可改善。在多变量分析中，服用更多药物(优势比[OR]=1.06；95%可信区间[CI]=1.04-1.08；P<；.001)和有多种药物过敏(OR=1.07；95%CI=1.03-1.11；P=.001)的患者更有可能讨论症状。男性医生(OR=1.20，95%CI=1.09-1.26；P=.002)和两个诊所的医生更有可能改变治疗方法(OR=1.24；95%CI=1.17-1.28；P<；.001；和OR=1.17；95%CI=1.08-1.24；P=.002)。结论：初级保健医生可以通过诱导和处理患者的用药症状来减少许多ADE的持续时间和/或严重程度。
Background: Little is known about the prevalence and character of medication-related symptoms in primary care and their relationship to adverse drug events (ADEs) or about factors that affect patient-physician communication regarding medication symptoms.Methods: The study included 661 patients who received prescriptions from physicians at 4 adult primary care practices. We interviewed patients 2 weeks and 3 months after the index visit, reviewed patients' medical records, and surveyed physicians whose patients identified medication-related symptoms. Physician reviewers determined whether medication symptoms constituted true ADEs. We used multivariable regression to examine factors associated with patients' decision to discuss symptoms with a physician and with physicians' decision to alter therapy.Results: A total of 179 patients identified 286 medication-related symptoms but discussed only 196 (69%) with their physicians. Physicians changed therapy in response to 76% of reported symptoms. Patients' failure to discuss 90 medication symptoms resulted in 19 (21%) ameliorable and 2 (2%) preventable ADEs. Physicians' failure to change therapy in 48 cases resulted in 31 (65%) ameliorable ADEs. In multivariable analyses, patients who took more medications (odds ratio [OR] = 1.06; 95% confidence interval [CI] = 1.04-1.08; P< .001) and had multiple medication allergies (OR= 1.07; 95% CI = 1.03-1.11; P= .001) were more likely to discuss symptoms. Male physicians (OR= 1.20, 95% CI= 1.09-1.26; P= .002) and physicians at 2 practices were more likely to change therapy (OR= 1.24; 95% CI= 1.17-1.28; P< .001; and OR= 1.17; 95% CI= 1.08-1.24; P= .002).Conclusion: Primary care physicians may be able to reduce the duration and/or the severity of many ADEs by eliciting and addressing patients' medication symptoms.