ORS PACA, Southeastern Health Regional Observatory, Marseille, France.
Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France.
Clin Interv Aging. 2021 Jan 7;16:19-34. doi: 10.2147/CIA.S283496. eCollection 2021.
In France, polypharmacy among older people living in nursing homes (NH) is a major public health concern. In this context, the randomized controlled trial TEM-EHPAD was recently launched in various NH in southern France to evaluate the impact of implementing a novel telemedication review (TMR) on hospital admission rates of NH residents at high risk of iatrogenic disease. A qualitative study was integrated into the main trial study to assess general practitioners' (GP) and other NH healthcare professionals' (HP) acceptability of the proposed TMR before its implementation.
A qualitative study using face-to-face semi-structured interviews was conducted with 16 HP before the beginning of the intervention. A manual thematic analysis was performed on the transcribed interviews.
Four main themes emerged from the thematic analysis: HP perceptions of the TMR, difficulties related to medication management for NH residents, HP perceptions of the roles of different professionals, and facilitators of good practices. Most participants were favorable to the TMR, but some GP expressed fears about loss of control over their prescription writing.
This study fulfilled its objective to assess pre-intervention acceptability by GP and other HP. Results provided important information about how to adapt the TMR intervention to make it more acceptable to HP who will be involved in TEM-EHPAD. One of the main recommendations is the importance of providing participating GP with the opportunity to take part in the process of reviewing prescriptions.
在法国，养老院（NH）中老年人的多种药物治疗是一个主要的公共卫生问题。在这种情况下，最近在法国南部的各种 NH 中启动了一项随机对照试验 TEM-EHPAD，以评估实施新的远程药物治疗审查（TMR）对有发生医源性疾病风险的 NH 居民住院率的影响。在实施之前，将一项定性研究纳入主要试验研究中，以评估全科医生（GP）和其他 NH 医疗保健专业人员（HP）对拟议的 TMR 的可接受性。
在干预开始前，对 16 名 HP 进行了一项使用面对面半结构化访谈的定性研究。对转录的访谈进行了手动主题分析。
主题分析产生了四个主要主题：HP 对 TMR 的看法、NH 居民药物管理方面的困难、HP 对不同专业人员角色的看法以及良好实践的促进因素。大多数参与者对 TMR 持赞成态度，但一些 GP 对失去对处方书写的控制表示担忧。
这项研究实现了评估 GP 和其他 HP 预先干预可接受性的目标。结果提供了有关如何使 TMR 干预措施更能被参与 TEM-EHPAD 的 HP 接受的重要信息。主要建议之一是为参与的 GP 提供审查处方过程的机会的重要性。
