改善基层医疗中患有多种疾病患者的药物管理：MY COMRADE实施干预措施的定性可行性研究
Improving medication management for patients with multimorbidity in primary care: a qualitative feasibility study of the MY COMRADE implementation intervention.
作者信息
Sinnott Carol, Byrne Molly, Bradley Colin P
机构信息
Department of General Practice, Western Gateway Building, University College Cork, Cork, Ireland.
Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland.
出版信息
Pilot Feasibility Stud. 2017 Mar 20;3:14. doi: 10.1186/s40814-017-0129-8. eCollection 2017.
BACKGROUND
For the majority of patients with multimorbidity, the prescription of multiple long-term medications (polypharmacy) is indicated. However, polypharmacy poses a risk of adverse drug events, drug interactions and excessive treatment burdens. To help general practitioners (GPs) conduct more comprehensive medication reviews for patients with multimorbidity, we developed the theoretically-informed MultimorbiditY COllaborative Medication Review And DEcision Making (MY COMRADE) implementation intervention. In this study, we assessed the feasibility and acceptability of MY COMRADE by GPs.
METHODS
A non-randomised feasibility study using a qualitative framework approach was conducted. General practices were recruited by purposively sampling from interested GPs attending continuing professional development meetings (CPD) in southwest Ireland. Participating practices were instructed on the MY COMRADE implementation intervention which has five components: (i) action planning; (ii) allocation of protected time; (iii) peer-supported medication review; (iv) use of a prescribing checklist and (v) self-incentives (allocation of CPD points). GPs in participating practices agreed to conduct medication reviews on multimorbid patients from their own caseload using the MY COMRADE approach. After completing these reviews, qualitative interviews were conducted to evaluate GPs' experiences of the intervention and were analysed using the framework method.
RESULTS
GPs from ten practices participated in the study. The GPs reported that MY COMRADE was an acceptable approach to implementing medication review in general practice, especially for complex patients with multimorbidity. Action plans for the medication reviews varied between practices, but all reviews led to recommendations for optimising medications and patient safety. Many GPs felt that using the MY COMRADE approach would ultimately lead to more efficient use of their time, but a minority felt that the time and cost implications of using two GPs to review medications would not be sustainable unless greater incentives were used.
CONCLUSIONS
This study demonstrates that MY COMRADE is an acceptable and feasible approach to supporting comprehensive medication reviews for patients with multimorbidity. These findings indicate that a large scale trial of the effectiveness of MY COMRADE is now required to fully evaluate its potential to change prescribing behaviour and improve downstream outcomes such as prescribing appropriateness and treatment burden.
TRIAL REGISTRATION
ISRCTN registry: ISRCTN34837446.
背景
对于大多数患有多种疾病的患者，需要开具多种长期药物处方（多重用药）。然而，多重用药存在药物不良事件、药物相互作用和治疗负担过重的风险。为帮助全科医生（GP）对患有多种疾病的患者进行更全面的药物评估，我们开发了理论依据充分的多重疾病协作药物评估与决策制定（MY COMRADE）实施干预措施。在本研究中，我们评估了全科医生对MY COMRADE的可行性和可接受性。
方法
采用定性框架方法进行非随机可行性研究。通过从爱尔兰西南部参加继续职业发展会议（CPD）的感兴趣的全科医生中进行目的抽样来招募全科医疗诊所。向参与的诊所介绍了MY COMRADE实施干预措施，该措施有五个组成部分：（i）行动计划；（ii）分配保护时间；（iii）同伴支持的药物评估；（iv）使用处方清单；（v）自我激励（分配CPD学分）。参与诊所的全科医生同意使用MY COMRADE方法对其自己病例中的患有多种疾病的患者进行药物评估。完成这些评估后，进行定性访谈以评估全科医生对该干预措施的体验，并使用框架方法进行分析。
结果
来自十个诊所的全科医生参与了该研究。全科医生报告说，MY COMRADE是在全科医疗中实施药物评估的一种可接受的方法，特别是对于患有多种疾病的复杂患者。不同诊所的药物评估行动计划各不相同，但所有评估都产生了优化药物和患者安全的建议。许多全科医生认为使用MY COMRADE方法最终将更有效地利用他们的时间，但少数人认为，除非使用更大的激励措施，否则使用两名全科医生进行药物评估的时间和成本影响将不可持续。
结论
本研究表明，MY COMRADE是支持对患有多种疾病的患者进行全面药物评估的一种可接受且可行的方法。这些发现表明，现在需要对MY COMRADE的有效性进行大规模试验，以全面评估其改变处方行为和改善下游结果（如处方适宜性和治疗负担）的潜力。
试验注册
ISRCTN注册库：ISRCTN34837446。
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