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“参与”患者和医疗保健专业人员的监管药物警戒:建立概念和方法框架。

'Engagement' of patients and healthcare professionals in regulatory pharmacovigilance: establishing a conceptual and methodological framework.

机构信息

University of Amsterdam, Nieuwe Achtergracht 166, 1018 WV, Amsterdam, The Netherlands.

European Medicines Agency (EMA), Domenico Scarlattilaan 6, Amsterdam, 1083 HS, The Netherlands.

出版信息

Eur J Clin Pharmacol. 2019 Sep;75(9):1181-1192. doi: 10.1007/s00228-019-02705-1. Epub 2019 Jun 25.

Abstract

BACKGROUND

Engagement of patients and healthcare professionals is increasingly considered as fundamental to pharmacovigilance and risk minimisation activities. Few empirical studies of engagement exist and a lack of explicit conceptualisations impedes effective measurement, research and the development of evidence-based engagement interventions.

AIMS

This article (1) develops a widely applicable conceptualisation, (2) considers various methodological challenges to researching engagement, proposing some solutions, and (3) outlines a basis for converting the conceptualisation into specific measures and indicators of engagement among stakeholders.

METHOD

We synthesise social science work on risk governance and public understandings of science with insights from studies in the pharmacovigilance field.

FINDINGS

This leads us to define engagement as an ongoing process of knowledge exchange among stakeholders, with the adoption of this knowledge as the outcome which may feed back into engagement processes over time. We conceptualise this process via three dimensions; breadth, depth and texture. In addressing challenges to capturing each dimension, we emphasise the importance of combining survey approaches with qualitative studies and secondary data on medicines use, prescribing, adverse reaction reporting and health outcomes. A framework for evaluating engagement intervention processes and outcomes is proposed. Alongside measuring engagement via breadth and depth, we highlight the need to research the engagement process through attentiveness to texture-what engagement feels like, what it means to people, and how this shapes motivations based on values, emotions, trust and rationales.

CONCLUSION

Capturing all three dimensions of engagement is vital to develop valid understandings of what works and why, thus informing engagement interventions of patients and healthcare professionals to given regulatory pharmacovigilance scenarios.

摘要

背景

患者和医疗保健专业人员的参与越来越被认为是药物警戒和风险最小化活动的基础。现有的参与度实证研究较少,缺乏明确的概念化阻碍了有效测量、研究和基于证据的参与干预措施的发展。

目的

本文(1)制定一个广泛适用的概念化方案,(2)考虑研究参与度的各种方法学挑战,提出一些解决方案,并(3)概述将概念化转化为利益相关者参与度的具体措施和指标的基础。

方法

我们综合了社会科学领域关于风险治理和公众对科学理解的工作,以及药物警戒领域研究的见解。

发现

这使我们将参与定义为利益相关者之间持续的知识交流过程,而知识的采用则是随着时间的推移可能反馈到参与过程中的结果。我们通过三个维度来概念化这个过程:广度、深度和纹理。在解决每个维度的捕获挑战时,我们强调了将调查方法与关于药物使用、处方、不良反应报告和健康结果的定性研究和二手数据相结合的重要性。提出了评估参与干预过程和结果的框架。除了通过广度和深度衡量参与度之外,我们还强调需要通过关注纹理来研究参与过程——参与的感觉如何、对人们意味着什么,以及这如何根据价值观、情感、信任和理由塑造动机。

结论

捕捉参与的所有三个维度对于深入了解什么有效和为什么有效至关重要,从而为患者和医疗保健专业人员提供针对特定监管药物警戒情景的参与干预措施。

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