Caplan Liron, Haverhals Leah M
Veterans Affairs Medical Center, Denver, CO 80220, USA.
Int J Risk Saf Med. 2012;24(2):81-94. doi: 10.3233/JRS-2012-0561.
To understand the practices medical care providers and health care staff utilize in managing and preventing Adverse Drug Reactions of Long Latency (ADRLLs) among their patients on medications such as glucocorticoids.
Qualitative study of key informant interviews.
Denver Department of Veterans Affairs (VA) Medical Center.
Fourteen physician providers and health care staff (nurses and pharmacists) in primary care and rheumatology.
A trained interviewer conducted semi-structured interviews in which providers and health care staff were asked about their processes for tracking and averting ADRLLs. PARTICIPANTS were asked about barriers and facilitators to monitoring ADRLLs and solicited for suggestions to improve existing processes. Interviews were analyzed using ATLAS.ti software.
Providers overwhelmingly commented on barriers, rather than facilitators. Six core themes emerged regarding ADRLL management barriers: patient noncompliance, provider workload, complications coordinating care, provider unfamiliarity with ADRLLs, lack of a standardized monitoring system, and communication failures. Ideas to improve the monitoring of ADRLLs fell into two domains: improving automated computer generated reminders or assigning a specific person to monitor potential ADRLLs.
Interviewees strongly endorsed a more systematic approach to ADRLL management, either through less intrusive computer-generated system reminders or through a dedicated staff person, such as a pharmacist, who could more closely monitor potential ADRLLs. There was disagreement among interviewees about who is responsible for monitoring ADRLLs (specialists versus primary care providers, VA versus non-VA providers, residents versus attending physicians).
了解医疗服务提供者和医护人员在管理和预防服用糖皮质激素等药物的患者发生迟发性药物不良反应（ADRLLs）时所采用的做法。
关键 informant 访谈的定性研究。
丹佛退伍军人事务部（VA）医疗中心。
初级保健和风湿病领域的 14 名医生、医护人员（护士和药剂师）。
一名经过培训的访谈者进行半结构化访谈，询问医疗服务提供者和医护人员追踪和避免 ADRLLs 的流程。询问参与者监测 ADRLLs 的障碍和促进因素，并征求改进现有流程的建议。使用 ATLAS.ti 软件对访谈进行分析。
医疗服务提供者压倒性地提到了障碍而非促进因素。出现了六个关于 ADRLL 管理障碍的核心主题：患者不依从、医疗服务提供者工作量、协调护理的并发症、医疗服务提供者对 ADRLLs 不熟悉、缺乏标准化监测系统以及沟通失败。改善 ADRLLs 监测的想法分为两个领域：改进自动计算机生成的提醒或指定专人监测潜在的 ADRLLs。
受访者强烈支持采用更系统的方法来管理 ADRLLs，要么通过侵入性较小的计算机生成系统提醒，要么通过专门的工作人员，如药剂师，来更密切地监测潜在的 ADRLLs。受访者对于谁负责监测 ADRLLs（专科医生与初级保健提供者、VA 提供者与非 VA 提供者、住院医生与主治医生）存在分歧。
