Clinical Pharmacology and Toxicology, University of New South Wales, Sydney, New South Wales, Australia.
Age Ageing. 2011 Mar;40(2):254-9. doi: 10.1093/ageing/afq160. Epub 2010 Dec 26.
non-steroidal anti-inflammatory drugs (NSAIDs) are used commonly to treat osteoarthritis in older patients.
to explore the understandings of risk that older-aged primary care patients have in the context of the use of oral NSAIDs to treat osteoarthritis.
semi-structured interviews were conducted with 15 patients who were recruited from four general practices located in Sydney, Australia. Patients were aged at least 65 years and were currently taking, or in the past 2 years had taken, an NSAID for osteoarthritis. Emergent themes were identified from the transcripts and were compared within and across transcripts to develop more abstract concepts.
patients demonstrated three key 'modes of disengagement' from medication-specific risk information, each of which could also be a mode of modulating a sense of danger and each of which would demand a unique clinical response. These were: 'transference of responsibility'-transferring the responsibility to their GP, 'general versus specific risk'-considering the risk of taking medicine in general as opposed to the specific risk of taking an NSAID, and 'personal immunity'-some patients with a long history of NSAID use without apparent toxicity believed they were, therefore, not at risk of future adverse effects, while a few patients believed they were immune to adverse effects of drugs in general.
there is a need for greater recognition of these 'modes of disengagement'/'hazard modulation' in order to attain a clinical response leading to safer, more effective and more ethical use of medicines.
非甾体抗炎药（NSAIDs）常用于治疗老年患者的骨关节炎。
探讨老年初级保健患者在使用口服 NSAIDs 治疗骨关节炎时对风险的理解。
从澳大利亚悉尼的四个全科诊所招募了 15 名年龄至少 65 岁、目前正在服用或在过去 2 年内服用 NSAIDs 治疗骨关节炎的患者进行半结构化访谈。从转录本中确定了出现的主题，并在转录本内和跨转录本进行比较，以开发更抽象的概念。
患者表现出三种从特定药物风险信息中“脱离”的关键“模式”，每种模式也可以是调节危险感的模式，每种模式都需要独特的临床反应。这些是：“责任转移”-将责任转移给他们的全科医生，“一般风险与具体风险”-将服用药物的风险视为一般，而不是服用 NSAID 的具体风险，以及“个人免疫力”-一些长期使用 NSAID 且没有明显毒性的患者认为他们因此不会有未来不良影响的风险，而少数患者则认为他们对一般药物的不良反应有免疫力。
需要更多地认识到这些“脱离模式”/“危险调节”，以实现更安全、更有效和更符合伦理的药物使用的临床反应。
