Aguiar João Pedro, Gama Marques João, Leufkens Hubert G M, Alves da Costa Filipa
Research Institute for Medicines (iMED.ULisboa), Faculdade de Farmácia, Universidade de Lisboa, Lisboa, Portugal.
Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), Caparica, Portugal.
Front Psychiatry. 2022 May 23;13:885216. doi: 10.3389/fpsyt.2022.885216. eCollection 2022.
Many challenges in elderly pharmacotherapy are identified, including the use of Potentially Inappropriate Medications (PIMs) which may increase the odds of adverse events, especially in elderly patients with mental health disorders (e. g., behavioral, and psychological symptoms of dementia-BPSD, schizophrenia, bipolar disorder). However, information on the knowledge and practice of healthcare professionals (HCPs) about this topic is still scarce.
A cross-sectional study was undertaken from July-October 2019. An online questionnaire was specifically designed and validated for this study. We sought HCPs (physicians, pharmacists, and nurses) worldwide, using (a) social media, via Facebook, Twitter, and LinkedIn; and (b) email contacts of the research team (convenience sample). Either way participants were asked to share on their social media or via e-mail the questionnaires with other HCPs (snowballing sample). The survey assessed two main domains: knowledge and practice. Knowledge was evaluated by self-report (perceived knowledge by a 5-item Likert confidence scale) and using three clinical cases, scored between 0 and 30 points (each one rated from 0 to 10 points; real knowledge). Barriers in clinical practice were evaluated using a 5-item Likert scale judging practitioners' opinion.
A total of 165 questionnaires were collected. HCPs were mainly female ( = 114; 69.1%), with a mean age of 35.3 ± 11.3 years old. Seventy-two percent ( = 118) were pharmacists, 21.1% ( = 35) were physicians, and 7.3% ( = 12) nurses. There was a weak correlation, albeit significant, between perceived and real knowledge (r = 0.199; = 0.001). The mean score of the clinical vignettes regarding elderly patients with dementia and bipolar disorder were 4.59 ± 4.08 and 4.86 ± 2.97 points, respectively. Most HCPs were classified as having an intermediate knowledge ( = 100; 60.6%) about medication complexities in the elderly with mental disorders. Most HCPs agreed that lack of time (81.6%; = 138), lack of education and training on elderly pharmacotherapy (72.2%; = 122), and lack of tools adapted to daily practice (61.8%; = 105) were the main barriers.
Most of the HCPs felt confident to manage medication complexities in elder patients with mental disorders, but only a minority obtained a good score in the knowledge assessment test. The main barriers identified included structural barriers (tools unfit for practice) and process barriers (time).
老年药物治疗存在诸多挑战，其中包括使用潜在不适当药物（PIMs），这可能会增加不良事件的发生几率，尤其是在患有精神疾病的老年患者中（例如，痴呆症的行为和心理症状 - BPSD、精神分裂症、双相情感障碍）。然而，关于医疗保健专业人员（HCPs）在这一主题上的知识和实践的信息仍然匮乏。
于2019年7月至10月进行了一项横断面研究。专门为此研究设计并验证了一份在线问卷。我们通过以下方式寻找全球的HCPs（医生、药剂师和护士）：（a）利用社交媒体，通过脸书、推特和领英；（b）研究团队的电子邮件联系人（便利样本）。无论采用哪种方式，参与者都被要求在其社交媒体上或通过电子邮件与其他HCPs分享问卷（滚雪球样本）。该调查评估了两个主要领域：知识和实践。知识通过自我报告（使用5项李克特信心量表感知的知识）以及三个临床病例进行评估，得分在0至30分之间（每个病例从0至10分进行评分；实际知识）。使用5项李克特量表评估临床实践中的障碍，以判断从业者的意见。
共收集到165份问卷。HCPs主要为女性（n = 114；69.1%），平均年龄为35.3±11.3岁。72%（n = 118）为药剂师，21.1%（n = 35）为医生，7.3%（n = 12）为护士。感知知识与实际知识之间存在微弱但显著的相关性（r = 0.199；p = 0.001）。关于老年痴呆症和双相情感障碍患者的临床病例 vignettes 的平均得分分别为4.59±4.08分和4.86±2.97分。大多数HCPs被归类为对患有精神障碍的老年人的药物复杂性具有中等知识水平（n = 100；60.6%）。大多数HCPs同意，时间不足（81.6%；n = 138）、缺乏老年药物治疗的教育和培训（72.2%；n = 122）以及缺乏适合日常实践的工具（61.8%；n = 105）是主要障碍。
大多数HCPs对管理患有精神障碍的老年患者的药物复杂性充满信心，但只有少数人在知识评估测试中获得高分。确定的主要障碍包括结构障碍（工具不适合实践）和过程障碍（时间）。
