Bruyère Research Institute, Ottawa, Ontario, Canada.
Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.
PLoS One. 2022 Aug 31;17(8):e0272418. doi: 10.1371/journal.pone.0272418. eCollection 2022.
Prescribing cascades, where a medication is used to treat the side effect of another medication, contribute to polypharmacy and related morbidity. Little is known about clinicians' and patients' experiences with prescribing cascades. In this study, we explored why and how prescribing cascades occur across a variety of care settings and how they are managed.
This descriptive qualitative study employed semi-structured interviews with older adults who may have experienced a prescribing cascade(s), their caregivers, and healthcare providers. Interviewees were recruited through physician referral from a Geriatric Day Hospital, two long-term care homes in Ottawa, Ontario, and through self-referral across Ontario, Canada. An inductive approach was used to code data and determine themes. Thirty-one interviews were conducted for ten unique patient cases. Some interviewees were involved in more than one case, resulting in 22 unique interviewees. Three themes were identified. First, recognition of prescribing cascades is linked to awareness of medication side effects. Second, investigation and management of prescribing cascades is simultaneous and iterative (rather than linear and sequential). Third, prevention of prescribing cascades requires intentional strategies to help people anticipate and recognize medication side effects. Difficulty with recruitment from both long-term care homes and through self-referral was the central limitation. This exemplifies challenges associated with studying a poorly recognized and underexplored phenomenon.
In order to better recognize, investigate and manage prescribing cascades, clinicians and patients need to know more about medication side effects; they need to ask 'can this be caused by a drug?' when signs and symptoms arise or worsen; and they need access to information about medication experiences to have benefit-risk discussions and make decisions about deprescribing. Approaches for raising public awareness of prescribing cascades should be trialed to raise the profile of this issue and facilitate continued exploration of the phenomenon.
药物治疗方案的级联（即一种药物用于治疗另一种药物的副作用）会导致多种药物并用和相关发病率的增加。人们对临床医生和患者在药物治疗方案级联方面的经验知之甚少。在这项研究中，我们探讨了导致药物治疗方案级联发生的原因和方式，以及如何对其进行管理。
本描述性定性研究采用半结构式访谈，受访者为可能经历过药物治疗方案级联（多个级联）的老年人及其护理人员和医疗保健提供者。通过医生从渥太华的一家老年日间医院、安大略省的两家长期护理院的推荐，以及在加拿大安大略省的自我推荐招募了受访者。采用归纳法对数据进行编码并确定主题。对十个独特的患者病例进行了 31 次访谈。一些受访者参与了不止一个病例，因此有 22 名独特的受访者。确定了三个主题。首先，识别药物治疗方案级联与对药物副作用的认识有关。其次，药物治疗方案级联的调查和管理是同时进行且迭代的（而不是线性和顺序的）。第三，预防药物治疗方案级联需要有针对性的策略来帮助人们预测和识别药物副作用。从长期护理院和自我推荐中招募的困难是核心限制。这说明了研究一种认识不足和探索不足的现象所面临的挑战。
为了更好地识别、调查和管理药物治疗方案级联，临床医生和患者需要更多地了解药物副作用；当出现或恶化症状和体征时，他们需要问“这是药物引起的吗？”；并且他们需要获得药物使用经验的信息，以便进行利弊讨论并做出减药决策。应该尝试提高公众对药物治疗方案级联的认识，以提高这一问题的知名度，并促进对这一现象的持续探索。
