由医师助理替代医生提供医院病房护理对药物处方指南遵从性的影响。
The effects of substitution of hospital ward care from medical doctors to physician assistants on non-adherence to guidelines on medication prescribing.
机构信息
Department of Clinical Pharmacy, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands.
Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, Nijmegen, The Netherlands.
出版信息
PLoS One. 2018 Aug 23;13(8):e0202626. doi: 10.1371/journal.pone.0202626. eCollection 2018.
AIM
This study determined the effect of substitution of inpatient care from medical doctors (MDs) to physician assistants (PAs) on non-adherence to guidelines on medication prescribing.
METHODS
A multicenter matched-controlled study was performed comparing wards on which PAs provide medical care in collaboration with MDs (PA/MD model), with wards on which only MDs provide medical care (MD model). A set of 17 quality indicators to measure non-adherence to guidelines on medication prescribing by PAs and MDs was composed by 14 experts in a modified Delphi procedure. The indicators covered different pharmacotherapeutic subjects, such as gastric protection in case of use of NSAID or prevention of obstipation in case of use of opioids. These indicators were expressed in proportions by dividing the number of patients in which the prescriber did not adhere to a guideline, by all patients that were applicable. Multivariable regression analysis was performed in order to adjust for potential confounders.
RESULTS
1021 patients from 17 hospital wards in the 'PA/MD model' group and 1286 patients from 17 hospital wards in the 'MD model' group were included. Two of the 17 quality indicators showed significantly less non-adherence to guidelines for the PA/MD model; the indicators concerning prescribing gastric protection in case of use of NSAID in combination with corticosteroids (OR 0.42, 95% CI 0.19-0.90) and in case of use of NSAID in patients older than 70 years (OR 0.47, 95% 0.23-0.95). For none of the other quality indicators for prescribing of medication a difference between the MD model and the PA/MD model was found.
CONCLUSION
This study suggests that the non-adherence to guidelines on medication prescribing on wards with the PA/MD model does not differ from wards with traditional house staffing by MDs only. Further research is needed to determine quality, efficiency and safety of prescribing behavior of PAs.
目的
本研究旨在确定将住院医师（MD）的住院护理替代为医师助理（PA）对药物处方指南遵守情况的影响。
方法
本研究采用多中心匹配对照研究，比较了 PA 与 MD 合作提供医疗服务的病房（PA/MD 模式）和仅由 MD 提供医疗服务的病房（MD 模式）。通过 14 位专家的改良 Delphi 程序，组成了一套 17 个质量指标，用于衡量 PA 和 MD 对药物处方指南的遵守情况。这些指标涵盖了不同的药物治疗主题，例如在使用 NSAID 时进行胃保护或在使用阿片类药物时预防便秘。这些指标通过将未遵守指南的患者数量除以适用患者数量，以比例表示。采用多变量回归分析来调整潜在混杂因素。
结果
纳入了来自 PA/MD 模式组 17 个病房的 1021 例患者和来自 MD 模式组 17 个病房的 1286 例患者。这 17 个质量指标中有 2 个显示 PA/MD 模式的指南遵守情况明显更好；这两个指标分别是在使用 NSAID 与皮质类固醇联合治疗时（OR 0.42，95%CI 0.19-0.90）和在 70 岁以上患者中使用 NSAID 时（OR 0.47，95%CI 0.23-0.95）开具胃保护药物。对于其他药物处方质量指标，MD 模式和 PA/MD 模式之间均未发现差异。
结论
本研究表明，PA/MD 模式病房的药物处方指南遵守情况与传统的 MD 单人病房并无差异。需要进一步研究以确定 PA 的处方行为的质量、效率和安全性。
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