Cullinan Shane, Fleming Aoife, O'Mahony Denis, Ryan Cristin, O'Sullivan David, Gallagher Paul, Byrne Stephen
Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland.
Br J Clin Pharmacol. 2015 May;79(5):860-9. doi: 10.1111/bcp.12555.
Older patients commonly suffer from multimorbidites and take multiple medications. As a result, these patients are more vulnerable to potentially inappropriate prescribing (PIP). PIP in older patients may result in adverse drug events (ADEs) and hospitalizations. However, little has been done to identify why PIP occurs. The objectives of this study were (i) to identify hospital doctors' perceptions as to why PIP occurs, (ii) to identify the barriers to addressing the issues identified and (iii) to determine which intervention types would be best suited to improving prescribing.
Semi-structured interviews based on the Theoretical Domains Framework (TDF), a tool used to apply behaviour change theories, were conducted with 22 hospital doctors. Content analysis was conducted to identify domains of the TDF that could be targeted to improve prescribing for older people. These domains were then mapped to the behaviour change wheel to identify possible intervention types.
Content analysis identified five of the 12 domains in the TDF as relevant: (i) environmental context and resources, (ii) knowledge, (iii) skills, (iv) social influences and (v) memory/attention and decision processes. Using the behaviour change wheel, the types of interventions deemed suitable were those based on training and environmental restructuring.
This study shows that doctors feel there is insufficient emphasis on geriatric pharmacotherapy in their undergraduate/postgraduate training. An intervention providing supplementary training, with particular emphasis on decision processes and dealing with social influences would be justified. This study has, however, uncovered many areas for potential intervention in the future.
老年患者通常患有多种疾病并服用多种药物。因此，这些患者更容易出现潜在不适当处方（PIP）。老年患者的PIP可能导致药物不良事件（ADEs）和住院。然而，对于识别PIP发生的原因，人们做得很少。本研究的目的是：（i）确定医院医生对PIP发生原因的看法；（ii）确定解决已识别问题的障碍；（iii）确定哪种干预类型最适合改善处方。
基于理论领域框架（TDF）（一种用于应用行为改变理论的工具）对22名医院医生进行了半结构化访谈。进行内容分析以确定TDF中可针对改善老年人处方的领域。然后将这些领域映射到行为改变轮，以确定可能的干预类型。
内容分析确定TDF的12个领域中有5个相关：（i）环境背景和资源；（ii）知识；（iii）技能；（iv）社会影响；（v）记忆/注意力和决策过程。使用行为改变轮，认为合适的干预类型是基于培训和环境重组的干预。
本研究表明，医生认为在本科/研究生培训中对老年药物治疗的重视不足。提供补充培训的干预措施，特别强调决策过程和应对社会影响是合理的。然而，本研究发现了未来许多潜在的干预领域。
