General practitioners' views on ( long- term) prescription and use of problematic and potentially inappropriate medication for oldest- old patients- A qualitative interview study with GPs ( CIM- TRIAD study)
General practitioners' views on ( long- term) prescription and use of problematic and potentially inappropriate medication for oldest- old patients- A qualitative interview study with GPs ( CIM- TRIAD study)
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DOI：
10.1186/s12875-017-0595-3
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发表时间：
2017-02-17
影响因子：
2.9
通讯作者：
Scherer, Martin
中科院分区：
文献类型：
--
作者：
Pohontsch, Nadine Janis;Heser, Kathrin;Scherer, Martin
背景：潜在不适当的药物（PIM）被定义为治疗效果不确定和/或潜在的药物不良反应超过临床获益的药物。尽管存在PIM清单（如PRISCUS清单）和努力提高认识，但高龄患者的PIM处方率仍然很高。本研究旨在确定全科医生对PIM的看法，以及影响PIM（长期）使用的因素。方法：作为CIM- TRIAD研究的一部分，我们对47名全科医生进行了半结构化的定性访谈，讨论了25名PIM患者和22名非PIM患者（根据PRISCUS列表）。访谈指南包括一般性和患者特异性问题。采访被数字记录下来，并逐字抄写。我们运用演绎和归纳范畴展开法对访谈内容进行了分析。结果：大多数全科医生不了解PRISCUS清单。从全科医生的角度来看，被认为可能不合适的药物和PRISCUS清单并不完全重叠。全科医生列出了他们确定老年患者适当用药的标准（如肾功能、认知状态），并强调了监测的重要性。我们确定了处方（例如，替代私人处方上的苯二氮卓类药物）、药物（例如，主观认为PIM没有替代方案）、全科医生（例如，全科医生依赖专家）、患者(例如。“要求高的用户”，积极的主观收益-风险-比率)和系统相关方面（例如缺乏整体观点的专家，界面问题）与（长期）使用PIM有关。结论：虽然PRISCUS清单似乎在全科实践中没有发挥决定性作用，但全科医生很清楚与PIM相关的风险。我们的研究确定了更安全处理PIM的一些起点，例如，更有力地传播PRISCUS清单，更好地补偿药物评论，“积极清单”，充分的患者信息，多方面的干预以及改善全科医生和专家之间的沟通。
Background: Potentially inappropriate medication (PIM) is defined as medication with uncertain therapeutic effects and/ or potential adverse drug reactions outweighing the clinical benefits. The prescription rate of PIM for oldest- old patients is high despite the existence of lists of PIM (e. g. the PRISCUS list) and efforts to raise awareness. This study aims at identifying general practitioners' views on PIM and aspects affecting the (long- term) use of PIM.Methods: As part of the CIM- TRIAD study, we conducted semi- structured, qualitative interviews with 47 general practitioners, discussing 25 patients with and 22 without PIM (according to the PRISCUS list). The interview guideline included generic and patient- specific questions. Interviews were digitally recorded and transcribed verbatim. We content analyzed the interviews using deductive and inductive category development.Results: The majority of the general practitioners were not aware of the PRISCUS list. Agents deemed potentially inappropriate from the general practitioners' point of view and the PRISCUS list are not completely superimposable. General practitioners named their criteria to identify appropriate medication for elderly patients (e. g. renal function, cognitive state) and emphasized the importance of monitoring. We identified prescription- (e. g. benzodiazepines on alternative private prescription), medication- (e. g. subjective perception that PIM has no alternative), general practitioner- (e. g. general practitioner relies on specialists), patient( e. g. " demanding high- user", positive subjective benefit- risk- ratio) and system- related aspects (e. g. specialists lacking holistic view, interface problems) related to the (long term) use of PIM.Conclusions: While the PRISCUS list does not seem to play a decisive role in general practice, general practitioners are well aware of risks associated with PIM. Our study identifies some starting points for a safer handling of PIM, e. g. stronger dissemination of the PRISCUS list, better compensation of medication reviews, " positive lists", adequate patient information, multifaceted interventions and improved communication between general practitioners and specialists.