Cullinan Shane, O'Mahony Denis, Fleming Aoife, Byrne Stephen
Pharmaceutical Care Research Group, School of Pharmacy, Cavanagh Pharmacy Building, University College Cork, College Road, Cork, Ireland,
Drugs Aging. 2014 Aug;31(8):631-8. doi: 10.1007/s40266-014-0190-4.
Potentially inappropriate prescribing (PIP) is commonly seen amongst the older population in all clinical settings, as indicated by several prevalence studies in several countries. Quantitative work such as this confirms that this is a global public health problem likely to grow in tandem with ageing of the global population. However, less attention has been focused on why it is happening and how it can be prevented.
The objective of this paper is to synthesise qualitative studies that explore PIP in older patients, in an effort to understand why it happens from a prescriber's perspective and to generate a new theory to guide future interventional studies aimed at minimising it in older people. To date, there is no published systematic synthesis of this type.
Papers were deemed suitable for inclusion if they used qualitative methods, explored some area of PIP in patients over 65 years of age, were published in English and had available published abstracts. Four databases were systematically searched for papers published up to the end of April 2013: PubMed, Embase, CINAHL and Web of Knowledge. No date restrictions were applied. Key words searched were: Qualitative AND (Inappropriate* OR Appropriate* OR Safe) AND (Elderly OR Aged OR Geriatric* OR Old*) AND Prescri*. Reference lists were then searched for other suitable papers. Critical Appraisal Skills Programme criteria were used to assess quality. Meta-ethnography was used to synthesise the papers.
Out of 624 papers identified, seven papers were deemed relevant. Four key concepts were identified as being causal factors in PIP: (1) the need to please the patient, (2) feeling of being forced to prescribe, (3) tension between prescribing experience and prescribing guidelines and (4) prescriber fear. These were re-interpreted in a line of argument synthesis indicating that some doctors have self-perceived restrictions with regard to prescribing appropriately because of a combination of factors, rather than any one dominant factor.
Prevention of PIP may be favourably influenced by addressing the key interactive determinants of inappropriate prescribing behaviour.
多项患病率研究表明，在所有临床环境中，老年人中普遍存在潜在不适当处方（PIP）现象。此类定量研究证实，这是一个全球性公共卫生问题，且可能随着全球人口老龄化而加剧。然而，对于其发生原因及预防方法的关注较少。
本文旨在综合探讨老年患者中PIP现象的定性研究，以便从开处方者的角度理解其发生原因，并生成一种新理论，为未来旨在减少老年人PIP现象的干预性研究提供指导。迄今为止，尚无此类已发表的系统综述。
若论文采用定性方法、探讨了65岁以上患者PIP的某些方面、以英文发表且有公开的摘要，则被视为适合纳入。系统检索了四个数据库，以查找截至2013年4月底发表的论文：PubMed、Embase、CINAHL和Web of Knowledge。未设日期限制。检索的关键词为：定性且（不适当或适当或安全）且（老年人或老年或老年或年老）且开处方*。随后检索参考文献列表以查找其他合适的论文。使用批判性评估技能计划标准评估质量。采用元民族志方法对论文进行综合分析。
在识别出的624篇论文中，7篇被认为相关。确定了四个关键概念为PIP的因果因素：（1）取悦患者的需求，（2）被迫开处方的感觉，（3）开处方经验与开处方指南之间的矛盾，以及（4）开处方者的恐惧。在一系列论证综合分析中对这些因素进行了重新诠释，表明一些医生由于多种因素而非单一主导因素的综合作用，在适当开处方方面存在自我认知的限制。
解决不适当处方行为的关键交互决定因素可能会对预防PIP产生有利影响。
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