Al Shemeili Saeed, Klein Susan, Strath Alison, Fares Saleh, Stewart Derek
Int J Clin Pharm. 2016 Feb;38(1):107-18. doi: 10.1007/s11096-015-0212-2.
Given the multiplicity of issues relating to medicines in the elderly, the structures and processes of medicines management should be clearly defined and described to optimise patient outcomes. There is a paucity of research which provides an in-depth exploration of these elements of medicines management for elderly patients.
This study explored health professionals’ experiences of medicines management for elderly, hospitalised patients in Abu Dhabi. Setting The research was conducted in five major hospitals in Abu Dhabi, the United Arab Emirates.
Responses to an online sampling questionnaire were used to purposively select nurses, pharmacists and physicians for interview. A semi-structured interview schedule was developed with reference to normalization process theory (NPT) and the theoretical domains framework (TDF) to explore issues of medicines management structures, processes and outcomes. Face-to-face interviews of 20–30 min were audio-recorded, transcribed verbatim and analysed using the Framework Approach.
Health professionals’ in-depth experiences of structures, processes and outcomes relating to medicines management. Results Saturation of themes was deemed to occur at interview 27 (7 nurses, 13 pharmacists, 7 physicians). Six key themes and several subthemes emerged from the qualitative analysis, which pertained to the need for: appropriate polypharmacy; a systematic approach to medicines history taking; improved communication and documentation; improved patients’ adherence to medicines; guidelines and policies to support medicines selection, and an educated and trained multidisciplinary team. The most dominant TDF behavioural determinants were issues around: professional role and identity; beliefs about capabilities; beliefs about consequences; environmental context and resources; knowledge, and goals. NPT construct identified little evidence of coherence, cognitive participation, collective action and reflexive monitoring.
The key themes identified in this research indicate the need to develop a more structured approach to medicines management in elderly hospitalised patients in Abu Dhabi. The NPT constructs and the TDF behavioural determinants can be utilised as part of service development and implementing change.
鉴于老年人用药相关问题的多样性，应明确界定和描述药物管理的结构与流程，以优化患者治疗效果。目前缺乏深入探讨老年患者药物管理这些要素的研究。
本研究探讨了阿联酋阿布扎比老年住院患者药物管理方面医护人员的经验。研究地点：该研究在阿联酋阿布扎比的五家主要医院开展。
采用在线抽样问卷的回复，有目的地挑选护士、药剂师和医生进行访谈。参照规范化过程理论（NPT）和理论领域框架（TDF）制定了半结构化访谈提纲，以探讨药物管理结构、流程和结果等问题。进行了20 - 30分钟的面对面访谈，进行录音、逐字转录，并采用框架分析法进行分析。
医护人员对药物管理结构、流程和结果的深入体验。结果：在第27次访谈（7名护士、13名药剂师、7名医生）时主题达到饱和。定性分析得出六个关键主题和若干子主题，涉及以下需求：合理的联合用药；系统的用药史采集方法；改善沟通与记录；提高患者的用药依从性；支持药物选择的指南和政策，以及一支受过教育和培训的多学科团队。TDF中最主要的行为决定因素围绕以下方面：专业角色与身份；对能力的信念；对后果的信念；环境背景与资源；知识，以及目标。NPT构建中几乎没有一致性、认知参与、集体行动和反思性监测的证据。
本研究确定的关键主题表明，需要为阿联酋阿布扎比的老年住院患者制定更结构化的药物管理方法。NPT构建和TDF行为决定因素可作为服务发展和实施变革的一部分加以利用。
