定性研究全科医生对多种药物治疗的看法。
Qualitative insights into general practitioners views on polypharmacy.
机构信息
Vaccine & Infectious Disease Institute & Centre for Primary Care, University of Antwerp, Belgium.
出版信息
BMC Fam Pract. 2010 Sep 15;11:65. doi: 10.1186/1471-2296-11-65.
BACKGROUND
Polypharmacy is common among older people. The purpose of this study is to describe GPs' views and beliefs on polypharmacy in order to identify the role of the GP in relation to improving prescribing behaviour. The awareness of these often established beliefs is key for understanding behaviour and promoting change which can guide action towards more rational prescribing.
METHODS
A qualitative descriptive methodology was used with semi-structured interviews. Interviews were conducted with 65 GPs from the region of Aalst, a district of a mixed urban and rural population in Belgium. The aim of the study was to describe the GPs' perspectives on polypharmacy in primary care.
RESULTS
GPs acknowledge that polypharmacy is a problem in their older patient population, especially because of the risk of adverse drug reactions, interactions and lowered adherence. GPs mention that difficulties in keeping an overview of the exact medication intake is an important problem caused by polypharmacy. The patients' strong belief in their medication and self-medication are seen as important barriers in reducing the number of drugs taken. Next to these patient related factors, there are some factors related to the prescriber, such as the lack of regular evaluation of the medication schedule by GPs and the involvement of several prescribers, especially in a hospital setting. According to the respondents, prevention and evidence based medicine guidelines often induce polypharmacy.
CONCLUSIONS
GPs point out that polypharmacy is an important problem in their older patient population. They see an important role for themselves in optimizing drug regimens for their patients. However, they do not have a readymade solution for polypharmacy. The limited set of options for addressing polypharmacy leave GPs feeling powerless to tackle the problem. There is a need for simple GP friendly tools and access to pharmacotherapeutic advice. Future research in this area and interventions seeking to improve prescribing for the elderly will have to focus on practical tools and take into account the GPs' sense of helplessness.
背景
老年人普遍存在多种用药情况。本研究旨在描述全科医生对多种用药的看法和信念，以确定全科医生在改善处方行为方面的作用。了解这些通常既定的信念是理解行为和促进变革的关键，这种变革可以指导更合理处方的行动。
方法
采用半结构式访谈的定性描述方法。访谈对象为比利时混合城乡人口地区阿尔斯特地区的 65 名全科医生。本研究旨在描述全科医生在初级保健中对多种用药的看法。
结果
全科医生承认，多种用药是老年患者群体的一个问题，尤其是因为存在药物不良反应、相互作用和降低依从性的风险。全科医生提到，由于多种用药，难以全面了解确切的药物摄入情况是一个重要问题。患者对药物的强烈信念和自我用药被视为减少用药数量的重要障碍。除了这些与患者相关的因素外，还有一些与处方者相关的因素，例如全科医生缺乏对药物治疗方案的定期评估以及涉及多名处方者的情况，尤其是在医院环境中。根据受访者的说法，预防和循证医学指南经常导致多种用药。
结论
全科医生指出，多种用药是老年患者群体中的一个重要问题。他们认为自己在优化患者的药物治疗方案方面发挥着重要作用。然而，他们没有现成的多种用药解决方案。解决多种用药的有限选择方案使全科医生感到无力解决这个问题。需要简单的、适合全科医生的工具，并获得药物治疗建议。未来在这一领域的研究和旨在改善老年人处方的干预措施将必须侧重于实用工具，并考虑到全科医生的无助感。
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