Heaton Janet, Britten Nicky, Krska Janet, Reeve Joanne
1Research Fellow,Institute of Health Research, University of Exeter Medical School,Exeter,Devon,UK.
2Professor,Institute of Health Research, University of Exeter Medical School,Exeter,Devon,UK.
Prim Health Care Res Dev. 2017 Jan;18(1):24-34. doi: 10.1017/S1463423616000207. Epub 2016 Jun 16.
Aim To examine how patient perspectives and person-centred care values have been represented in documents on medicines optimisation policy in England.
There has been growing support in England for a policy of medicines optimisation as a response to the rise of problematic polypharmacy. Conceptually, medicines optimisation differs from the medicines management model of prescribing in being based around the patient rather than processes and systems. This critical examination of current official and independent policy documents questions how central the patient is in them and whether relevant evidence has been utilised in their development.
A documentary analysis of reports on medicines optimisation published by the Royal Pharmaceutical Society (RPS), The King's Fund and National Institute for Health and Social Care Excellence since 2013. The analysis draws on a non-systematic review of research on patient experiences of using medicines. Findings The reports varied in their inclusion of patient perspectives and person-centred care values, and in the extent to which they drew on evidence from research on patients' experiences of polypharmacy and medicines use. In the RPS report, medicines optimisation is represented as being a 'step change' from medicines management, in contrast to the other documents which suggest that it is facilitated by the systems and processes that comprise the latter model. Only The King's Fund report considered evidence from qualitative studies of people's use of medicines. However, these studies are not without their limitations. We suggest five ways in which researchers could improve this evidence base and so inform the development of future policy: by facilitating reviews of existing research; conducting studies of patient experiences of polypharmacy and multimorbidity; evaluating medicines optimisation interventions; making better use of relevant theories, concepts and tools; and improving patient and public involvement in research and in guideline development.
目的 探讨患者观点和以患者为中心的护理价值观在英格兰药物优化政策文件中是如何体现的。
在英格兰，随着问题性多重用药情况的增加，对药物优化政策的支持日益增多。从概念上讲，药物优化与处方的药物管理模式不同，它是以患者为中心，而非围绕流程和系统。对当前官方和独立政策文件的这项批判性审视质疑了患者在这些文件中的核心地位，以及在其制定过程中是否利用了相关证据。
对皇家药学会（RPS）、国王基金和国家卫生与社会保健卓越研究所自2013年以来发布的关于药物优化的报告进行文献分析。该分析借鉴了对患者用药体验研究的非系统综述。结果 这些报告在纳入患者观点和以患者为中心的护理价值观方面以及在借鉴多重用药和药物使用患者体验研究证据的程度方面存在差异。在RPS报告中，药物优化被描述为与药物管理的“重大转变”，而其他文件则表明它是由构成后者模式的系统和流程推动的。只有国王基金报告考虑了对人们用药情况定性研究的证据。然而，这些研究并非没有局限性。我们提出了研究人员可以改善这一证据基础从而为未来政策制定提供信息的五种方法：促进对现有研究的综述；开展多重用药和多病共存患者体验的研究；评估药物优化干预措施；更好地利用相关理论、概念和工具；以及提高患者和公众在研究及指南制定中的参与度。
