Knisely Mitchell R, Carpenter Janet S, Broome Marion E, Holmes Ann M, Von Ah Diane, Skaar Todd, Draucker Claire Burke
Duke University, Durham, North Carolina, USA.
Indiana University, Indianapolis, Indiana, USA.
Qual Rep. 2018 Aug;23(8):1861-1875. Epub 2018 Aug 7.
Current approaches to assessing medication exposure fail to capture the complexity of the phenomenon and the context in which it occurs. This study's purpose was to develop a typology of subgroups of patients who share common patterns of medication exposure. To create the typology, we used an exemplar sample of 30 patients in a large public healthcare system who had been prescribed the pharmacogenetically actionable opioids codeine or tramadol. Data related to medication exposure were drawn from large data repositories. Using a person-oriented qualitative approach, eight subgroups of patients who shared common patterns of medication exposure were identified. The subgroups had one of five opioid prescription patterns (i.e., singular, episodic, switching, sustained, multiplex), and one of three types of primary foci of medical care (i.e., pain, comorbidities, both). The findings reveal medication exposure patterns that are dynamic, multidimensional, and complex, and the typology offers an innovative approach to assessing medication exposure.
当前评估药物暴露的方法未能捕捉到该现象的复杂性及其发生的背景。本研究的目的是建立具有共同药物暴露模式的患者亚组类型学。为了创建该类型学，我们在一个大型公共医疗系统中选取了30名患者作为示例样本，这些患者被开具了具有药物遗传学可操作的阿片类药物可待因或曲马多。与药物暴露相关的数据来自大型数据库。采用以人为本的定性方法，确定了具有共同药物暴露模式的八个患者亚组。这些亚组具有五种阿片类药物处方模式之一（即单一、 episodic、转换、持续、多重），以及三种主要医疗关注点之一（即疼痛、合并症、两者皆有）。研究结果揭示了动态、多维且复杂的药物暴露模式，该类型学为评估药物暴露提供了一种创新方法。
