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以消费者为目标的减药干预是否会损害患者与医疗服务提供者之间的信任?

Does a Consumer-Targeted Deprescribing Intervention Compromise Patient-Healthcare Provider Trust?

作者信息

Zhang Yi Zhi, Turner Justin P, Martin Philippe, Tannenbaum Cara

机构信息

Faculté de Pharmacie, Université de Montréal, Montreal, QC H3T 1J4, Canada.

Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montréal, QC H3W 1W5, Canada.

出版信息

Pharmacy (Basel). 2018 Apr 16;6(2):31. doi: 10.3390/pharmacy6020031.

Abstract

One in four community-dwelling older adults is prescribed an inappropriate medication. Educational interventions aimed at patients to reduce inappropriate medications may cause patients to question their prescriber’s judgment. The objective of this study was to determine whether a patient-focused deprescribing intervention compromised trust between older adults and their healthcare providers. An educational brochure was distributed to community-dwelling older adults by community pharmacists in order to trigger deprescribing conversations. At baseline and 6-months post-intervention, participants completed the Primary Care Assessment Survey, which measures patient trust in doctors and pharmacists. Changes in trust were ascertained post-intervention. Proportions with 95% confidence intervals (CI), and logistic regression were used to determine a shift in trust and associated predictors. 352 participants responded to the questionnaire at both time points. The majority of participants had no change or gained trust in their doctors for items related to the choice of medical care (78.5%, 95% CI = 74.2–82.8), communication transparency (75.4%, 95% CI = 70.7–79.8), and overall trust (81.9%, 95% CI = 77.9–86.0). Similar results were obtained for participants’ perceptions of their pharmacists, with trust remaining intact for items related to the choice of medical care (79.4%, 95% CI = 75.3–83.9), transparency in communicating (82.0%, 95% CI = 78.0–86.1), and overall trust (81.6%, 95% CI = 77.5–85.7). Neither age, sex nor the medication class targeted for deprescribing was associated with a loss of trust. Overall, the results indicate that patient-focused deprescribing interventions do not shift patients’ trust in their healthcare providers in a negative direction.

摘要

四分之一居住在社区的老年人被开具了不适当的药物。旨在让患者减少不适当用药的教育干预措施可能会使患者质疑开处方者的判断力。本研究的目的是确定以患者为中心的减药干预是否会损害老年人与其医疗服务提供者之间的信任。社区药剂师向居住在社区的老年人分发了一份教育手册,以引发关于减药的讨论。在基线期和干预后6个月,参与者完成了初级保健评估调查,该调查衡量患者对医生和药剂师的信任度。干预后确定信任度的变化。使用95%置信区间(CI)的比例和逻辑回归来确定信任度的变化及相关预测因素。352名参与者在两个时间点都对问卷做出了回应。大多数参与者在与医疗护理选择相关的项目(78.5%,95%CI=74.2-82.8)、沟通透明度(75.4%,95%CI=70.7-79.8)以及总体信任(81.9%,95%CI=77.9-86.0)方面对医生没有改变信任或增加了信任。参与者对药剂师的看法也得到了类似结果,在与医疗护理选择相关的项目(79.4%,95%CI=75.3-83.9)、沟通透明度(82.0%,95%CI=78.0-86.1)以及总体信任(81.6%,95%CI=77.5-85.7)方面信任保持不变。年龄、性别以及针对减药的药物类别均与信任丧失无关。总体而言,结果表明以患者为中心的减药干预不会使患者对其医疗服务提供者的信任向负面方向转变。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/df0a/6024917/258d67c75654/pharmacy-06-00031-g001a.jpg

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