Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium.
BMJ Qual Saf. 2022 Dec;31(12):888-898. doi: 10.1136/bmjqs-2021-014372. Epub 2022 Mar 29.
A patient-centred approach to medicines optimisation is considered essential. The OPtimising thERapy to prevent Avoidable hospital admissions in Multimorbid older people (OPERAM) trial evaluated the effectiveness of medication review with shared decision-making (SDM) in older people with multimorbidity. Beyond evaluating the clinical effectiveness, exploring the patient experience facilitates a better understanding of contextual factors and mechanisms affecting medication review effectiveness.
To explore experiences of hospital-initiated medication changes in older people with multimorbidity.
We conducted a multicentre mixed-methods study, embedded in the OPERAM trial, combining semi-structured interviews and the Beliefs about Medicines Questionnaire (BMQ) with a purposive sample of 48 patients (70-94 years) from four European countries. Interviews were analysed using the Framework approach. Trial implementation data on SDM were collected and the 9-item SDM questionnaire was conducted with 17 clinicians.
Patients generally displayed positive attitudes towards medication review, yet emphasised the importance of long-term, trusting relationships such as with their general practitioners for medication review. Many patients reported a lack of information and communication about medication changes and predominantly experienced paternalistic decision-making. Patients' beliefs that 'doctors know best', 'blind trust', having limited opportunities for questions, use of jargon terms by clinicians, 'feeling too ill', dismissive clinicians, etc highlight the powerlessness some patients felt during hospitalisation, all representing barriers to SDM. Conversely, involvement of companions, health literacy, empathetic and trusting patient-doctor relationships, facilitated SDM. Paradoxical to patients' experiential accounts, clinicians reported high levels of SDM. The BMQ showed that most patients had high necessity and low concern beliefs about medicines. Beliefs about medicines, experiencing benefits or harms from medication changes, illness perception, trust and balancing advice between different healthcare professionals all affected acceptance of medication changes.
To meet patients' needs, future medicines optimisation interventions should enhance information exchange, better prepare patients and clinicians for partnership in care and foster collaborative medication reviews across care settings.
以患者为中心的药物优化方法被认为是至关重要的。OPtimising thERapy to prevent Avoidable hospital admissions in Multimorbid older people（OPERAM）试验评估了在患有多种疾病的老年人中进行药物审查和共同决策（SDM）的有效性。除了评估临床效果外，探索患者体验有助于更好地理解影响药物审查效果的背景因素和机制。
探讨患有多种疾病的老年人中因医院干预而改变药物治疗的经验。
我们进行了一项多中心混合方法研究，该研究嵌入在 OPERAM 试验中，结合了半结构化访谈和药物信念问卷（BMQ），对来自四个欧洲国家的 48 名（70-94 岁）患者进行了有针对性的抽样。使用框架方法对访谈进行分析。收集了关于 SDM 的试验实施数据，并对 17 名临床医生进行了 9 项 SDM 问卷的调查。
患者对药物审查普遍持积极态度，但强调了长期、信任的关系的重要性，例如与他们的全科医生的关系，以便进行药物审查。许多患者报告说缺乏关于药物改变的信息和沟通，主要经历了家长式的决策。患者的信念是“医生最了解”、“盲目信任”、提问机会有限、临床医生使用行话术语、“感觉太不适”、态度轻蔑的临床医生等，这些都突显了一些患者在住院期间感到无助，这些都构成了 SDM 的障碍。相反，同伴的参与、健康素养、富有同理心和信任的医患关系有助于 SDM 的实施。与患者的体验描述相反，临床医生报告了高水平的 SDM。BMQ 显示，大多数患者对药物的必要性和关注程度都很高。对药物的信念、从药物改变中体验到的益处或危害、疾病认知、信任以及平衡不同医疗保健专业人员的建议都影响了对药物改变的接受程度。
为了满足患者的需求，未来的药物优化干预措施应加强信息交流，更好地为患者和临床医生做好合作护理的准备，并促进跨护理环境的协作药物审查。
