Swimming Against the Tide: Primary Care Physicians' Views on Deprescribing in Everyday Practice
Swimming Against the Tide: Primary Care Physicians' Views on Deprescribing in Everyday Practice
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DOI：
10.1370/afm.2094
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发表时间：
2017-07-01
影响因子：
4.4
通讯作者：
Henderson, Michelle
中科院分区：
文献类型：
--
作者：
Wallis, Katharine A.;Andrews, Abby;Henderson, Michelle
避免因药物不良反应和高风险处方而住院在老年人中很常见。初级保健医生处方大多数正在使用的药物。长期以来，取消处方一直是最佳处方实践的关键。我们试图探讨的障碍和便利的初级保健医生在日常实践中取消处方的意见，告知发展的干预措施，以支持更安全的prescribing.METHODS我们使用了滚雪球抽样技术，以确定潜在的参与者。医生的选择是基于多年的实践，就业状况和实践环境，并额外关注信息丰富的参与者。24个半结构化的采访录音，逐字转录，并分析，以确定紧急themes.Results医生描述为“游泳的潮流”的病人的期望，医疗文化的处方，和组织的限制。他们说，取消处方对他们自己和病人都有固有的风险，并在实践中传达了一种脆弱感。他们认为，取消处方的唯一动机是为病人做正确的事情。医生建议进行组织变革以支持更安全的处方，包括为年度药物审查提供有针对性的资金，计算机提示，改善处方者之间的信息流，改善获得专家建议和用户友好的决策支持，增加非药物治疗的可用性，并加强患者参与药物管理。个人的，关系的，和组织的限制取消。应制定法规和政策，支持医生按照其职业道德价值观执业。
PURPOSE Avoidable hospitalizations due to adverse drug events and high-risk prescribing are common in older people. Primary care physicians prescribe most on-going medicines. Deprescribing has long been essential to best prescribing practice. We sought to explore the views of primary care physicians on the barriers and facilitators to deprescribing in everyday practice to inform the development of an intervention to support safer prescribing.METHODS We used a snowball sampling technique to identify potential participants. Physicians were selected on the basis of years in practice, employment status, and practice setting, with an additional focus on information-rich participants. Twenty-four semistructured interviews were audio-recorded, transcribed verbatim, and analyzed to identify emergent themes.RESULTS Physicians described deprescribing as "swimming against the tide" of patient expectations, the medical culture of prescribing, and organizational constraints. They said deprescribing came with inherent risks for both themselves and patients and conveyed a sense of vulnerability in practice. The only incentive to deprescribing they identified was the duty to do what was right for the patient. Physicians recommended organizational changes to support safer prescribing, including targeted funding for annual medicines review, computer prompts, improved information flows between prescribers, improved access to expert advice and user-friendly decision support, increased availability of non-pharmaceutical therapies, and enhanced patient engagement in medicines management.CONCLUSIONS Interventions to support safer prescribing in everyday practice should consider the sociocultural, personal, relational, and organizational constraints on deprescribing. Regulations and policies should be designed to support physicians in practicing according to their professional ethical values.