School of Pharmacy, University of Otago, Dunedin, New Zealand.
Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand.
BMC Fam Pract. 2021 Jul 10;22(1):150. doi: 10.1186/s12875-021-01451-7.
Medicines are central to healthcare in aging populations with chronic multi-morbidity. Their safe and effective use relies on a large and constantly increasing knowledge base. Despite the current era of unprecedented access to information, there is evidence that unmet information needs remain an issue in clinical practice. Unmet medicines information needs may contribute to sub-optimal use of medicines and patient harm. Little is known about medicines information needs in the primary care setting. The aim of this study was to investigate the nature of medicines information needs in routine general practice and understand the challenges and influences on the information-seeking behaviour of general practitioners.
A mixed methods study involving 18 New Zealand general practitioner participants was undertaken. Quantitative data were collected to characterize the medicines information needs arising during 642 consultations conducted by the participants. Qualitative data regarding participant views on their medicines information needs, resources used, challenges to meeting the needs and potential solutions were collected by semi-structured interview. Integration occurred by comparison of results from each method.
Of 642 consultations, 11% (n = 73/642) featured at least one medicines information need. The needs spanned 14 different categories with dosing the most frequent (26%) followed by side effects (15%) and drug interactions (14%). Two main themes describing the nature of general practitioners' medicines information needs were identified from the qualitative data: a 'common core' related to medicine dose, side effects and interactions and a 'perplexing periphery'. Challenges in the perplexing periphery were the variation in information needs, complexity, 'known unknowns' and 'unknown unknowns'. Key factors affecting general practitioners' strategies for meeting medicines information needs were trust in a resource, presence of the patient, how the information was presented, scarcity of time, awareness of the existence of a resource, and its accessibility.
General practitioners face challenges in meeting wide-ranging medicines information needs in patients with increasingly complex care needs. Recognising the challenges and factors that influence resource use in practice can inform optimisation of medicines information support resources. Resources for general practitioners must take into account the complexity and time constraints of real-world practice. An individually responsive approach involving greater collaboration with pharmacists and specialist medicines information support services may provide a potential solution.
在老龄化且患有多种慢性病的人群中，药物是医疗保健的核心。安全有效地使用药物依赖于庞大且不断增加的知识库。尽管当前正处于信息空前获取的时代，但有证据表明，临床实践中仍存在未满足的信息需求问题。未满足的药物信息需求可能导致药物使用不当和患者伤害。在初级保健环境中，人们对药物信息需求知之甚少。本研究旨在调查常规全科医疗中药物信息需求的性质，并了解全科医生信息寻求行为的挑战和影响。
本研究采用混合方法，共纳入 18 名新西兰全科医生参与者。收集定量数据以描述参与者进行的 642 次就诊中出现的药物信息需求。通过半结构化访谈收集参与者对其药物信息需求、使用的资源、满足需求的挑战和潜在解决方案的看法的定性数据。通过比较每种方法的结果进行整合。
在 642 次就诊中，有 11%（n=73/642）至少有一个药物信息需求。这些需求涵盖了 14 个不同的类别，其中剂量最常见（26%），其次是副作用（15%）和药物相互作用（14%）。从定性数据中确定了描述全科医生药物信息需求性质的两个主要主题：与药物剂量、副作用和相互作用相关的“共同核心”以及“令人困惑的外围”。令人困惑的外围的挑战是信息需求的变化、复杂性、“已知的未知”和“未知的未知”。影响全科医生满足药物信息需求策略的关键因素包括对资源的信任、患者的存在、信息呈现方式、时间短缺、对资源存在的认识及其可及性。
全科医生在满足具有日益复杂护理需求的患者广泛的药物信息需求方面面临挑战。认识到实践中影响资源使用的挑战和因素，可以为优化药物信息支持资源提供信息。为全科医生提供的资源必须考虑到实际工作中的复杂性和时间限制。一种涉及与药剂师和专门药物信息支持服务更大程度合作的个性化响应方法可能提供潜在的解决方案。
