Linsky Amy, Simon Steven R, Stolzmann Kelly, Bokhour Barbara G, Meterko Mark
VA Boston Healthcare System, 150 S. Huntington Ave, Boston, MA 02130. E-mail:
Am J Manag Care. 2016 Nov;22(11):747-754.
Primary care providers (PCPs) and clinical pharmacists have concerns about the adverse consequences of using medications inappropriately and generally support the notion of reducing unnecessary drugs. Despite this attitude, many factors impede clinicians' ability to discontinue medication in clinical settings. We sought to develop a survey instrument that assesses PCPs' and pharmacists' experiences, attitudes, and beliefs toward medication discontinuation.
Survey development and psychometric assessment.
Based on a conceptual framework, we developed a questionnaire and surveyed a national sample of Department of Veterans Affairs PCPs with prescribing privileges, including physicians, nurse practitioners, physician assistants, and clinical pharmacy specialists. We randomly divided respondents into derivation and validation samples and used iterations of multi-trait analysis to assess the psychometric properties of the proposed measures. Multivariable regression models identified factors associated with the outcome of self-rated comfort with medication discontinuation.
Using established criteria for scale development, we identified 5 scales: Medication Characteristics, Current Patient Clinical Factors, Predictions of Future Health States, Patients' Resources to Manage Their Own Health, and Education and Experience. Three of these dimensions predicted providers' self-rated comfort with making decisions to discontinue medication (Current Patient Clinical Factors, Predictions of Future Health States, and Education and Experience).
We developed a psychometrically sound instrument to measure prescribers' attitudes toward, and experiences with, medication discontinuation. This survey will enable identification of perceived barriers to, and facilitators of, proactive discontinuation-an important step toward developing interventions that improve the quality and safety of care in medication use.
初级保健提供者（PCP）和临床药师担心不恰当地使用药物会产生不良后果，并且普遍支持减少不必要药物的理念。尽管有这种态度，但许多因素阻碍了临床医生在临床环境中停用药物的能力。我们试图开发一种调查工具，以评估初级保健提供者和药师对药物停用的经验、态度和信念。
调查工具开发和心理测量评估。
基于一个概念框架，我们编制了一份问卷，并对具有处方权的退伍军人事务部初级保健提供者的全国样本进行了调查，这些提供者包括医生、执业护士、医师助理和临床药学专家。我们将受访者随机分为推导样本和验证样本，并使用多特质分析的迭代方法来评估所提议措施的心理测量特性。多变量回归模型确定了与自我评定的药物停用舒适度结果相关的因素。
使用既定的量表开发标准，我们确定了5个量表：药物特性、当前患者临床因素、未来健康状况预测、患者自我管理健康的资源以及教育与经验。这些维度中的三个预测了提供者对做出药物停用决策的自我评定舒适度（当前患者临床因素、未来健康状况预测以及教育与经验）。
我们开发了一种心理测量学上合理的工具，以测量开处方者对药物停用的态度和经验。这项调查将有助于识别主动停用药物的感知障碍和促进因素——这是朝着开发改善用药护理质量和安全性的干预措施迈出的重要一步。
