Department of Primary and Long-term Care, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Alzheimer Center Groningen, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Medicine for Older People, de Boelelaan 1117, Amsterdam, Netherlands; Amsterdam Public Health Research Institute, Aging & Later Life, Amsterdam, Netherlands.
Int J Med Inform. 2023 Sep;177:105132. doi: 10.1016/j.ijmedinf.2023.105132. Epub 2023 Jun 21.
Guidelines recommend reluctant psychotropic drug (PD) prescribing in nursing home residents with dementia and neuropsychiatric symptoms (NPS), as efficacy of PDs is limited, and side effects are common. Nevertheless, PDs are commonly prescribed to reduce NPS. A smartphone application that evaluates appropriateness of PD prescriptions and provides recommendations from the revised Dutch guideline on problem behaviour in dementia may promote guideline adherence and increase appropriate prescribing.
This study aimed to assess user experiences, barriers and facilitators of the Dutch 'Psychotropic Drug Tool' smartphone application (PDT) in the context of appropriate prescribing of PDs to nursing home residents with dementia and NPS.
METHODS/DESIGN: The PDT was developed according to the recommendations of the Dutch guideline for treatment of NPS in people with dementia. Feedback provided during usability testing with two end-users was applied to improve the PDT before implementation in day-to-day practice. Sixty-three prescribers were asked to use the PDT at their own convenience for four months. User expectations and experiences were assessed at baseline and after four months with the System Usability Scale and the Assessment of Barriers and Facilitators for Implementation.
Expected usability (M = 72.59; SD = 11.84) was similar to experienced usability after four months (M = 69.13; SD = 16.48). Appreciation of the PDTs user-friendliness (on average 6.7 out of 10) and design (7.3) were moderately positive, in contrast to the global rating of the PDT (5.7). Perceived barriers for PDT use were time consumption and lack of integration with existing electronic systems. Perceived facilitators were ease of use and attractive lay out. For broader implementation, physicians suggested a change in direction of the PDT: start assessment of appropriateness based on the list of NPS instead of PD as primary input.
In this pragmatic prospective cohort study we found that the PDT was used by elderly care physicians, with mediocre user satisfaction. The PDT will be optimized based on user feedback regarding experienced usability, barriers and facilitators, after which broader implementation can be initialized. The Medical Ethics Review Board of the University Medical Center Groningen declared this is a non-WMO study (UMCG RR Number: 201800284).
指南建议在患有痴呆症和神经精神症状（NPS）的养老院居民中慎重使用精神药物（PD），因为 PD 的疗效有限，且副作用常见。然而，PD 仍常被用于减轻 NPS。一款评估 PD 处方适宜性并提供修订后的荷兰痴呆症行为问题指南建议的智能手机应用程序，可能会促进指南的遵循并增加适宜的处方。
本研究旨在评估荷兰“精神药物工具”智能手机应用程序（PDT）在为患有痴呆症和 NPS 的养老院居民合理使用 PD 方面的用户体验、障碍和促进因素。
方法/设计：PDT 根据荷兰痴呆症患者 NPS 治疗指南的建议开发。在对两名最终用户进行可用性测试期间提供的反馈信息，在实际应用前被用于改进 PDT。要求 63 名处方者在方便时自行使用 PDT 四个月。在基线和四个月后，使用系统可用性量表和实施障碍和促进因素评估来评估用户期望和体验。
预期的可用性（M=72.59；SD=11.84）与四个月后的实际体验相似（M=69.13；SD=16.48）。对 PDT 用户友好性（平均 10 分中得 6.7 分）和设计（7.3 分）的评价适中积极，而对 PDT 的整体评价（5.7 分）则较低。使用 PDT 的感知障碍是耗时和缺乏与现有电子系统的集成。感知的促进因素是易用性和有吸引力的布局。为了更广泛的实施，医生建议改变 PDT 的方向：从评估 NPS 清单而不是 PD 作为主要输入开始，评估适宜性。
在这项实用的前瞻性队列研究中，我们发现老年护理医生使用了 PDT，用户满意度中等。根据用户对实际可用性、障碍和促进因素的反馈，将对 PDT 进行优化，然后可以初始化更广泛的实施。格罗宁根大学医学中心医学伦理审查委员会宣布这是一项非世界医学协会（WMO）研究（UMCG RR 编号：201800284）。
