Everall Amanda C, Cadel Lauren, Lofters Aisha K, Packer Tanya L, Hitzig Sander L, Patel Tejal, Cimino Stephanie R, Guilcher Sara J T
Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.
Department of Family and Community Medicine, St. Michael's Hospital, University of Toronto, Toronto, Canada.
Disabil Rehabil. 2022 Apr;44(8):1252-1259. doi: 10.1080/09638288.2020.1799249. Epub 2020 Aug 5.
To compare the attitudes and preferences of persons with spinal cord injury/dysfunction (SCI/D) and healthcare providers regarding prescription medications, over-the-counter medications, and natural health products (NHPs).
A qualitative study involving semi-structured interviews with healthcare providers ( = 32) and persons with SCI/D ( = 19) in Canada. Inductive descriptive and interpretive analyses were conducted using data display matrices and a constant comparative approach.
Participants described differing perceptions of therapeutic benefits based on medication type, with shared attitudes about the therapeutic benefits of prescription medications and differing views about the effectiveness of NHPs. Despite the perceived effectiveness of prescription medications, persons with SCI/D preferred to avoid them due to concerns about side effects, safety, and stigma. Persons with SCI/D were often concerned about the long-term safety of prescription medications, whereas providers focused more on medication-related addictions. Participants discussed stigma relating to prescription medications, NHPs, and medicinal marijuana.
Healthcare providers and persons with SCI/D described different attitudes about and preferences for pharmacotherapeutic products, contributing to challenges in optimizing medication management. Strategies to improve medication management include shared decision-making to incorporate patient preferences into care plans and explicit discussions about long-term medication safety. Further, steps are needed to combat the stigma associated with medication use.Implications for rehabilitationFollowing a person-centered approach to shared decision-making, prescribers should initiate explicit conversations about patient medication preferences, short and long-term prescription medication side effects, and alternative treatment options.Regarding prescription medication safety, persons with spinal cord injury/dysfunction focused on the long term impact of medications, while providers focused on medication-related addictions, highlighting a disconnect that should be discussed during initiation, continuation, or discontinuation of a medication.Providers should be mindful of the stigma associated with taking multiple prescription medications, including medicinal marijuana, as well as the stigma associated with over-the-counter medications and natural health products.Providers could benefit from education about spinal cord injury/dysfunction-specific prescription medications and could benefit from increased education about natural health products.
比较脊髓损伤/功能障碍（SCI/D）患者与医疗服务提供者在处方药、非处方药和天然健康产品（NHPs）方面的态度和偏好。
一项定性研究，对加拿大的医疗服务提供者（n = 32）和SCI/D患者（n = 19）进行半结构化访谈。使用数据展示矩阵和持续比较法进行归纳性描述和解释性分析。
参与者根据药物类型描述了对治疗益处的不同看法，对处方药的治疗益处有共同态度，对NHPs的有效性看法不一。尽管处方药有明显疗效，但SCI/D患者因担心副作用、安全性和污名化而倾向于避免使用。SCI/D患者常关注处方药的长期安全性，而医疗服务提供者更关注药物成瘾问题。参与者讨论了与处方药、NHPs和药用大麻相关的污名化问题。
医疗服务提供者和SCI/D患者对药物治疗产品的态度和偏好不同，这给优化药物管理带来了挑战。改善药物管理的策略包括共同决策，将患者偏好纳入护理计划，并就长期药物安全性进行明确讨论。此外，需要采取措施消除与药物使用相关的污名化。
对康复的启示
遵循以患者为中心的共同决策方法，开处方者应就患者的药物偏好、短期和长期处方药副作用以及替代治疗方案展开明确对话。
关于处方药安全，脊髓损伤/功能障碍患者关注药物的长期影响，而医疗服务提供者关注药物成瘾问题，这凸显了在开始、持续或停用药物时应讨论的脱节之处。
医疗服务提供者应注意与服用多种处方药（包括药用大麻）相关的污名化，以及与非处方药和天然健康产品相关的污名化。
医疗服务提供者可从有关脊髓损伤/功能障碍特定处方药的教育中受益，也可从增加的天然健康产品教育中受益。
