Nature and frequency of exchanges on medications during primary care encounters
Nature and frequency of exchanges on medications during primary care encounters
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DOI：
10.1016/j.pec.2006.02.003
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发表时间：
2006-12-01
影响因子：
3.5
通讯作者：
Lussier, Marie-Therese
中科院分区：
文献类型：
--
作者：
Richard, Claude;Lussier, Marie-Therese
目的：描述的交流，有关讨论的所有药物在初级保健medical consultations.Methods：422医疗遭遇的录音描述性研究。编码是用MEDICODE完成的，MEDICODE是一种经过验证的工具，用于分析药物的口头交流。结果：平均3.9种药物（S.D.）= 2.8;范围1-21），每种药物涉及4.2个主题（S.D. = 2.6;范围1-17）。“积极讨论”、“重新处方”和“新处方”药物分别占所有讨论药物的43.1%、16.3%和10.6%。最常讨论的主题是名称，说明，观察到的主要效果，类别，服用药物的原因，药物的一般用途，对症状的预期效果，药物的形式，适应症，需要另一次咨询，以及替代药物。最不常讨论的主题包括具有临床意义的主题，如可能的不良反应、观察到的不良反应、对药物的态度和情绪表达、依从性和耐受性。讨论的主题的平均数量之间的药物，规定在遇到的，无论是新的处方或重新开药，相比，药物，只讨论了在遇到.Conclusion：我们的研究结果表明，药物讨论是异质性的，并与药物和主题的状态不同。此外，关于药物的讨论的性质和程度不支持共享决策model.Practice的影响：虽然它是为时过早的讨论药物的具体建议，它似乎很清楚，在医疗遇到的药物信息共享是一个过程，超出了任何一个单一的遭遇。虽然沟通技巧现在是大多数医疗课程的一部分，但显然需要提出在多次医患接触中建立患者用药知识的概念，并使医生更好地准备使用必要的特定内容和过程技能，以重新审视与药物相关的问题，这些问题似乎对支持患者的用药实践是必要的。(c)2006爱思唯尔爱尔兰有限公司保留所有权利。
Objective: To describe the exchanges, related to discussion of all medications during primary care medical consultations.Methods: Descriptive study of audio recordings of 422 medical encounters. Coding was done with MEDICODE, a validated instrument developed to analyse verbal exchanges on medications. The unit of analysis is the medication.Results: An average of 3.9 medications (S.D. = 2.8; range 1-21) are discussed per interview and 4.2 themes are broached for each drug (S.D. = 2.6; range 1-17). "Active Discussed", "Represcribed" and "Newly Prescribed" drugs account for 43.1, 16.3 and 10.6%, respectively of all medications discussed. Themes most often discussed are Name, Instructions, Observed Main Effect, Class, Reasons for Taking the Drug, General Use of the Medication, Expected Effect on Symptoms, Form of the Medication, Indications Another Consultation Needed, and Alternative Medication. The least often discussed themes include clinically significant ones such as Possible Adverse Effects, Observed Adverse Effects, Expression of Attitudes and Emotions with regard to the medication, Compliance and Warnings. The average number of themes discussed differed between medications that were prescribed during the encounter, either New prescriptions or Represcribed drugs, compared to medications that were only discussed during the encounter.Conclusion: Our results show that medication discussions are heterogeneous and vary with the status of the medication and the theme. Also, the nature and extent of the discussions about medications do not support the shared-decision making model.Practice implications: Though it is too soon to make specific recommendations about discussions on medications, it seems clear that information-sharing about medications during medical encounters is a process that extends beyond any single encounter. Although communication skills are now part of most medical curriculums, there is an obvious need to put forth the concept of patient medication knowledge-building over multiple physician-patient encounters and to better prepare physicians to use the specific content and process skills necessary to revisit issues related to medications that seem necessary to support their patients' medication-taking practices. (c) 2006 Elsevier Ireland Ltd. All rights reserved.