Denford S, Frost J, Dieppe P, Cooper Chris, Britten N
University of Exeter Medical School, Institute of Health Research, Exeter, UK.
BMJ Open. 2014 Mar 26;4(3):e004172. doi: 10.1136/bmjopen-2013-004172.
Patients and policy makers advocate that drug treatments should be individualised. However, the term is used in a variety of ways. We set out to identify the range of related terminology and concepts in the general field of individualisation, map out the relationships between these concepts and explore how patients' perspectives are considered.
We consulted members of an established patient and public involvement group about their experience of medicine taking for long-term conditions and their ideas about individualisation. We then conducted a scoping review of the literature to explore how terms surrounding individualisation of drug treatment are used and defined in the literature, and to explore the extent to which patients' perspectives are represented, with a view to informing future recommendations as to how individualisation can be operationalised.
We identified relevant literature using a range of search strategies. Two researchers independently extracted definitions of terms using a template. Inductive and deductive methods were used to explore the data.
Definitions were categorised according to the following themes: medical management; pharmacogenetics, the patient's perspective; interactions between the healthcare provider and patient and management of long-term conditions.
Within the literature reviewed, the involvement of patients in the ongoing management of drug treatment was largely absent. We propose the use of a new term 'mutually agreed tailoring' (MAT). This describes the ongoing pharmacological management of conditions that incorporates patients' specific needs, experiences and existing strategies for using their medications, and the professionals' clinical judgement. This usually includes patients monitoring their symptoms and, with the support of the professional, making appropriate product, dose or timing adjustments as necessary. Our previous work suggests that many patients and doctors are successfully practising MAT, so we suggest that a formal description may facilitate wider utilisation of strategies that will improve patient outcomes.
患者和政策制定者主张药物治疗应个体化。然而，该术语的使用方式多种多样。我们着手确定个体化这一总体领域中相关术语和概念的范围，梳理这些概念之间的关系，并探讨如何考虑患者的观点。
我们咨询了一个成熟的患者及公众参与小组的成员，了解他们长期服药的经历以及对个体化的看法。然后，我们对文献进行了范围综述，以探究药物治疗个体化相关术语在文献中的使用和定义方式，并探究患者观点的呈现程度，以便为未来关于如何实施个体化的建议提供参考。
我们使用一系列检索策略确定相关文献。两名研究人员使用模板独立提取术语的定义。采用归纳法和演绎法对数据进行探究。
定义根据以下主题进行分类：医疗管理；药物遗传学、患者视角；医疗服务提供者与患者之间的互动以及长期病症的管理。
在所审查的文献中，患者在药物治疗的持续管理中的参与情况基本未被涉及。我们建议使用一个新术语“共同商定的调整”（MAT）。这描述了对病症的持续药物管理，其中纳入了患者的特定需求、经验以及现有的用药策略，还有专业人员的临床判断。这通常包括患者监测自身症状，并在专业人员的支持下，根据需要对产品、剂量或用药时间进行适当调整。我们之前的研究表明，许多患者和医生都在成功实践MAT，所以我们认为正式的描述可能会促进那些能改善患者治疗效果的策略得到更广泛的应用。
