Patient and provider perceptions of intentional medication discontinuation

描述(由申请人提供)： 这是退伍军人管理局第二次提交HSR&D CDA提案，为艾米·林斯基医学博士和硕士提供五年的工资支持，以实现她发展成为退伍军人管理局独立调查员和药物安全研究专家的目标。林斯基博士是一名普通内科医生，也是退伍军人事务部波士顿医疗系统组织、领导力和管理研究(COLMR)高铁研发中心的研究员。这项提案勾勒出了研究和培训目标，这些目标将使林斯基博士成熟为一名独立的卫生服务研究员，同时为患者安全和护理质量领域做出贡献，特别是在您与适当用药有关的领域。第一个拟议的研究目标将集中在阐明退伍军人和临床医生对故意停药的观点，这是迄今为止尚未探索的处方过程的一部分。在正在进行的定性工作的基础上，林斯基博士将开发两种调查工具：一种是了解患者的态度和信念，另一种是了解临床医生如何看待过度用药和潜在的停药问题。将退伍军人的偏好纳入临床决策与退伍军人管理局促进以患者为中心的护理的其他努力是一致的。退伍军人管理局是医疗信息技术的先锋，拥有完善和完整的电子健康记录。尽管如此，药物差异仍然存在，有可能对患者造成严重伤害。一种类型的差异，治疗重复，可能会导致无意中过量用药。第二个研究目标建议在全国范围内确定退伍军人管理局内这种安全问题的流行率，并确定这些重复的相关因素。为了实现处方上有意义的改变，前两个研究目标的结果将与文献中的相关发现相结合，以开发和试行旨在促进考虑

DESCRIPTION (provided by applicant): This is the second submission of a VA HSR&D CDA proposal to provide five years of salary support to Amy Linsky, MD, MSc toward her goal of developing into a VA independent investigator and expert on medication safety research. Dr. Linsky is a general internist and an investigator in the HSR&D Center for Organization, Leadership, and Management Research (COLMR) at VA Boston Healthcare System. This proposal delineates the research and training objectives that will lead to Dr. Linsky's maturation into an independent health services researcher while contributing to the fields of patient safety and quality of care, especially as thy pertain to appropriate medication use. The first proposed research objective will center on elucidating Veterans' and clinicians' perspectives on intentional medication discontinuation, a part of the prescribing process that to date has not been explored. Building on qualitative work in progress, Dr. Linsky will develop two survey instruments: one to elicit patients' attitudes and beliefs and the other to understand how clinicians view overmedication and potential medication discontinuation. Bringing the Veterans' preferences into clinical decision making is concordant with other efforts in the VA to promote patient-centered care. The VA is a vanguard of health information technology, with a well-established and integrated electronic health record. Despite this, medication discrepancies, with potential to cause serious harm to patients, persist. One type of discrepancy, therapeutic duplication, can lead to unintentional overdose. The second research objective proposes to identify the prevalence of this safety concern within VA nationally and to identify correlates of these duplications. To effect meaningful change in prescribing, the results of these first two research objectives will be combined with relevant findings in the literature to develop and pilot test an intervention intended to promote consideration of