制定、验证和评估目标导向的药物审查电子决策支持系统（G-MEDSS）©。
Development, validation and evaluation of the Goal-directed Medication review Electronic Decision Support System (G-MEDSS)©.
机构信息
Departments of Clinical Pharmacology and Aged Care, Faculty of Medicine and Health, The University of Sydney, Kolling Institute, Royal North Shore Hospital, Sydney, New South Wales, Australia.
Departments of Clinical Pharmacology and Aged Care, Faculty of Medicine and Health, The University of Sydney, Kolling Institute, Royal North Shore Hospital, Sydney, New South Wales, Australia; Geriatric Medicine Research, Faculty of Medicine, and College of Pharmacy, Dalhousie University and Nova Scotia Health Authority, Halifax, Canada; Quality Use of Medicines and Pharmacy Research Centre, UniSA: Clinical and Health Science, University of South Australia, Adelaide, South Australia, Australia.
出版信息
Res Social Adm Pharm. 2022 Jul;18(7):3174-3183. doi: 10.1016/j.sapharm.2021.09.004. Epub 2021 Sep 14.
OBJECTIVES
- To understand and investigate the experiences of accredited clinical pharmacists (ACP) using computerised clinical decision support systems (CCDSS) during medication reviews for older people, including those living with dementia; 2) To design, develop, validate, and evaluate a CCDSS that incorporates pharmacological and other deprescribing tools to aid person-centred management of high-risk medications in older adults living with and without dementia.
METHODS
This study consisted of three phases and was designed on scenario-based methodology: a) the development phase, which included an exploratory survey and prototype building; b) the validation phase, which included qualitative data collection and usability testing with ACPs, general practitioners (GPs) and carers for people living with dementia; and c) the evaluation phase, using mixed-methods analyses.
RESULTS
The exploratory survey found that ACPs required a flexible, and reliable CCDSS to support them with clinical decisions regarding high-risk medication use in older adults. The Goal-directed Medication review Electronic Decision Support System (G-MEDSS)© was developed and validated using quantitative and qualitative feedback received from ACPs, GPs and carers for people with dementia. The mean (SD) System Usability Scale score was 69.0 (12.9), which indicated fair-good usability.
DISCUSSION AND CONCLUSIONS
Involving end-users in the design process refined and improved the design of G-MEDSS, allowing for a person-centred and goal-directed delivery of pharmaceutical care. G-MEDSS allows healthcare practitioners conducting medication reviews for older adults living with and without dementia to tailor pharmaceutical care to meet their goals and preferences. Future studies may explore integration of G-MEDSS with prescribing or dispensing software.
目的
1）了解和研究认证临床药师（ACP）在为老年人进行药物审查时使用计算机临床决策支持系统（CCDSS）的经验，包括那些患有痴呆症的老年人；2）设计、开发、验证和评估一个包含药理学和其他减药工具的 CCDSS，以帮助患有和不患有痴呆症的老年人进行以人为中心的高危药物管理。
方法
本研究包括三个阶段，基于情景方法设计：a）开发阶段，包括探索性调查和原型构建；b）验证阶段，包括与 ACP、全科医生（GP）和痴呆症患者的护理人员进行定性数据收集和可用性测试；c）评价阶段，使用混合方法分析。
结果
探索性调查发现，ACP 需要一个灵活、可靠的 CCDSS 来支持他们做出关于老年人高危药物使用的临床决策。目标导向药物审查电子决策支持系统（G-MEDSS）©是根据 ACP、GP 和痴呆症患者护理人员的反馈开发和验证的。系统可用性量表的平均（SD）得分是 69.0（12.9），表明可用性尚可。
讨论和结论
让最终用户参与设计过程可以完善和改进 G-MEDSS 的设计，从而实现以人为中心和目标导向的药物护理。G-MEDSS 允许为患有和不患有痴呆症的老年人进行药物审查的医疗保健从业者根据他们的目标和偏好调整药物护理。未来的研究可能会探索将 G-MEDSS 与处方或配药软件集成。
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