Barts Health NHS Trust, London, UK.
Department of Elderly Medicine, University Hospitals Sussex NHS Foundation Trust, Sussex, UK.
Br J Clin Pharmacol. 2023 Feb;89(2):672-686. doi: 10.1111/bcp.15502. Epub 2022 Sep 15.
Older adults are particularly affected by medication-related harm (MRH) during transitions of care. There are no clinical tools predicting those at highest risk of MRH post hospital discharge. The PRIME study (prospective study to develop a model to stratify the risk of MRH in hospitalized patients) developed and internally validated a risk-prediction tool (RPT) that provides a percentage score of MRH in adults over 65 in the 8 weeks following hospital discharge. This qualitative study aimed to explore the views of hospital pharmacists around enablers and barriers to clinical implementation of the PRIME-RPT.
Ten hospital pharmacists: (band 6, n = 3; band 7, n = 2; band 8, n = 5) participated in semistructured interviews at the Royal Sussex County Hospital (Brighton, UK). The pharmacists were presented with five case-vignettes each with a calculated PRIME-RPT score to help guide discussion. Case-vignettes were designed to be representative of common clinical encounters. Data were thematically analysed using a "framework" approach.
Seven themes emerged in relation to the PRIME-RPT: (1) providing a medicine-prioritisation aide; (2) acting as a deprescribing alert; (3) facilitating a holistic review of patient medication management; (4) simplifying communication of MRH to patients and the multidisciplinary team; (5) streamlining community follow-up and integration of risk discussion into clinical practice; (6) identifying barriers for the RPTs integration in clinical practice; and (7) acknowledging its limitations.
Hospital pharmacists found the PRIME-RPT beneficial in identifying older patients at high risk of MRH following hospital discharge, facilitating prioritising interventions to those at highest risk while still acknowledging its limitations.
老年人在医疗保健过渡期间特别容易受到与药物相关的伤害（MRH）的影响。目前还没有临床工具可以预测出院后发生 MRH 的风险最高的人群。PRIME 研究（旨在开发一种模型以对住院患者的 MRH 风险进行分层的前瞻性研究）开发并内部验证了一种风险预测工具（RPT），该工具可针对 65 岁以上成年人在出院后 8 周内发生 MRH 的风险提供百分比评分。这项定性研究旨在探讨医院药剂师对 PRIME-RPT 临床实施的促进因素和障碍的看法。
10 名医院药剂师（第 6 级，n=3；第 7 级，n=2；第 8 级，n=5）在英国布莱顿的皇家苏塞克斯郡医院（Royal Sussex County Hospital）参加了半结构化访谈。每位药剂师都收到了五个病例简介，每个病例简介都有一个计算出的 PRIME-RPT 评分，以帮助指导讨论。病例简介旨在代表常见的临床情况。使用“框架”方法对数据进行主题分析。
与 PRIME-RPT 相关的主题有 7 个：（1）提供药物优先排序辅助工具；（2）作为减药提醒；（3）促进对患者药物管理的全面审查；（4）简化与患者和多学科团队沟通 MRH；（5）简化社区随访和将风险讨论纳入临床实践；（6）确定 RPT 整合到临床实践中的障碍；（7）承认其局限性。
医院药剂师发现 PRIME-RPT 有助于识别出院后发生 MRH 风险较高的老年患者，有助于将干预措施优先用于风险最高的患者，同时仍承认其局限性。
