评估多药治疗行动学习工具对医疗保健从业者在停止使用不当药物方面的信心、认知和经验的影响。

Evaluating the impact of a polypharmacy Action Learning Sets tool on healthcare practitioners' confidence, perceptions and experiences of stopping inappropriate medicines.

机构信息

NIHR ARC Wessex and School of Health Sciences, University of Southampton, Southampton, SO17 1BJ, UK.

Public Health, Swindon Borough Council, Civic Offices, Swindon, SN1 2JH, Wiltshire, UK.

出版信息

BMC Med Educ. 2022 Jun 27;22(1):499. doi: 10.1186/s12909-022-03556-8.

DOI:10.1186/s12909-022-03556-8

PMID:35761284

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9235240/

Abstract

BACKGROUND

Issues of medication adherence, multimorbidity, increased hospitalisation risk and negative impact upon quality of life have led to the management of polypharmacy becoming a national priority. Clinical guidelines advise a patient-centred approach, involving shared decision-making and multidisciplinary team working. However, there have been limited educational initiatives to improve healthcare practitioners' management of polypharmacy and stopping inappropriate medicines. This study aimed to evaluate the impact of a polypharmacy Action Learning Sets (ALS) tool across five areas: i. healthcare practitioners' confidence and perceptions of stopping medicines; ii. knowledge and information sources around stopping medicines; iii. perception of patients and stopping medicines; iv. perception of colleagues and stopping medicines and v. perception of the role of institutional factors in stopping medicines.

METHODS

The ALS tool was delivered to a multi-disciplinary group of healthcare practitioners: GPs [n = 24] and pharmacy professionals [n = 9]. A pre-post survey with 28 closed statements across five domains relating to the study aims [n = 32] and a post evaluation feedback survey with 4 open-ended questions [n = 33] were completed. Paired pre-post ALS responses [n = 32] were analysed using the Wilcoxon signed-rank test. Qualitative responses were analysed using a simplified version of the constant comparative method.

RESULTS

The ALS tool showed significant improvement in 14 of 28 statements in the pre-post survey across the five domains. Qualitative themes (QT) from the post evaluation feedback survey include: i. awareness and management of polypharmacy; ii. opportunity to share experiences; iii. usefulness of ALS as a learning tool and iv. equipping with tools and information. Synthesised themes (ST) from analysis of pre-post survey data and post evaluation feedback survey data include: i. awareness, confidence and management of inappropriate polypharmacy, ii. equipping with knowledge, information, tools and resources and iii. decision-making and discussion about stopping medicines with colleagues in different settings.

CONCLUSIONS

This evaluation contributes to developing understanding of the role of educational initiatives in improving inappropriate polypharmacy, demonstrating the effectiveness of the ALS tool in improving healthcare practitioners' awareness, confidence and perceptions in stopping inappropriate medicines. Further evaluation is required to examine impact of the ALS tool in different localities as well as longer-term impact.

摘要

背景

药物依从性、多种合并症、住院风险增加以及对生活质量的负面影响，这些问题使得对多种药物疗法的管理成为国家的首要任务。临床指南建议采取以患者为中心的方法，包括共同决策和多学科团队合作。然而，提高医疗保健专业人员管理多种药物疗法和停止不适当药物的教育举措有限。本研究旨在评估一种多种药物疗法行动学习集（ALS）工具在五个方面的影响：i. 医疗保健从业者对停止用药的信心和看法；ii. 停止用药的知识和信息来源；iii. 对患者和停止用药的看法；iv. 对同事和停止用药的看法；v. 对机构因素在停止用药中的作用的看法。

方法

将 ALS 工具提供给一组多学科的医疗保健从业者：全科医生[24 人]和药剂师[9 人]。完成了一项涉及研究目标的五个领域的 28 个封闭陈述的预-后调查[32 人]，以及一项具有 4 个开放式问题的后评估反馈调查[33 人]。使用 Wilcoxon 符号秩检验分析 32 名配对预-后 ALS 参与者的反应。使用简化的常规定量方法分析定性反应。

结果

ALS 工具在五个领域的 28 个陈述中的 14 个陈述中显示出显著改善。后评估反馈调查的定性主题（QT）包括：i. 对多种药物疗法的认识和管理；ii. 分享经验的机会；iii. ALS 作为学习工具的有用性；iv. 提供工具和信息。对预-后调查数据和后评估反馈调查数据的综合主题（ST）分析包括：i. 对不适当的多种药物疗法的认识、信心和管理；ii. 提供知识、信息、工具和资源；iii. 在不同环境中与同事就停止用药做出决策和讨论。