Costa Olivia S, Salam Tabassum, Duhig Amy, Patel Aarti A, Cameron Ann, Voelker Jennifer, Bookhart Brahim, Coleman Craig I
School of Pharmacy, University of Connecticut, Storrs, CT, USA.
Evidence-Based Practice Center, Hartford Hospital, Hartford, CT, USA.
J Mark Access Health Policy. 2020 Mar 9;8(1):1738637. doi: 10.1080/20016689.2020.1738637. eCollection 2020.
: A non-medical switch is a change to a patient's medication regimen for reasons other than lack of clinical response, side-effects or poor adherence. Specialist physicians treat complex patients who may be vulnerable to non-medical switching. : To evaluate specialist physicians' perceptions regarding the frequency of non-medical switch requests, and the impact on their patients' outcomes and healthcare utilization. : An online survey of randomly sampled physicians spending ≥10% of time providing patient care and having received ≥1 non-medical switch request during the prior 12-months. : Among 404 specialist physicians surveyed, non-medical switch requests were reported as very frequent or frequent by 35.0% of oncologists (for injectable cancer agents) and up to 80.3% of endocrinologists (for injectable anti-hyperglycemics). Respondents reported decreased medication effectiveness (25.0% of oncologists to 75.0% of dermatologists) and increased side-effects (32.5% of oncologists to 66.7% of psychiatrists). Most specialists reported very frequent or frequent increases in non-office visits (52.5% of oncologists to 75.3% of endocrinologists) and calls with pharmacies (57.5% of oncologists to 80.5% of rheumatologists) due to non-medical switching. : Receipt of non-medical switching requests were common among specialist physicians. Non-medical switching may lead to negative effects on patient care and require increased healthcare utilization.
非医学性换药是指对患者用药方案进行改变，其原因并非缺乏临床疗效、出现副作用或依从性差。专科医生治疗的复杂患者可能容易出现非医学性换药情况。
评估专科医生对非医学性换药请求频率的看法，以及对其患者治疗结果和医疗资源利用的影响。
对随机抽样的医生进行在线调查，这些医生将≥10%的时间用于提供患者护理，且在过去12个月内收到≥1次非医学性换药请求。
在接受调查的404名专科医生中，35.0%的肿瘤学家（针对注射用抗癌药物）和高达80.3%的内分泌学家（针对注射用抗高血糖药物）报告称非医学性换药请求非常频繁或频繁。受访者报告药物有效性下降（从25.0%的肿瘤学家到75.0%的皮肤科医生）和副作用增加（从32.5%的肿瘤学家到66.7%的精神科医生）。大多数专科医生报告称，由于非医学性换药，非门诊就诊次数（从52.5%的肿瘤学家到75.3%的内分泌学家）和与药房的通话次数（从57.5%的肿瘤学家到80.5%的风湿病学家）非常频繁或频繁增加。
非医学性换药请求在专科医生中很常见。非医学性换药可能会对患者护理产生负面影响，并需要增加医疗资源利用。
