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手术前停药的障碍和促进因素:对提供者和老年人的定性研究。

Barriers and facilitators to deprescribing before surgery: A qualitative study of providers and older adults.

机构信息

Johns Hopkins School of Nursing, 525 N. Wolfe St., Baltimore, MD, 21205.

Medstar Georgetown University, 3800 Reservoir Road NW, Washington, DC, 20007, USA.

出版信息

Geriatr Nurs. 2023 Sep-Oct;53:135-140. doi: 10.1016/j.gerinurse.2023.07.018. Epub 2023 Aug 2.

DOI:10.1016/j.gerinurse.2023.07.018
PMID:37540907
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10528381/
Abstract

INTRODUCTION

Deprescribing, the collaborative process between providers and patients to streamline medication regimen, may reduce the risk of adverse events following surgery among older adults with multimorbidity. However, barriers and facilitators to deprescribing for surgery has not been explored.

METHODS

We conducted a qualitative study of Primary Care Providers (PCP) and patients aged 65 and older who were scheduled for surgery. We used the Theoretical Domains Framework, which informed the interview guide and analysis.

RESULTS

A total of 16 participants (n=8 providers, n=8 patients) were included. Themes were regarding: 1) attitudes towards deprescribing before surgery, 2) perceived benefits of deprescribing before surgery, 3) patient-provider relationship and shared decision-making, 4) hope for surgery, 5) barriers to deprescribing before surgery, and 6) preferences for deprescribing follow-up.

CONCLUSION

Our study findings regarding provider- and patient-related barriers and facilitators for deprescribing and desired processes before surgery may inform future deprescribing intervention targets before surgery.

摘要

简介

在患有多种疾病的老年人中,通过提供者和患者之间的协作来简化药物治疗方案的药物停用(deprescribing),可能会降低手术后发生不良事件的风险。但是,针对手术进行药物停用的障碍和促进因素尚未得到探索。

方法

我们对计划接受手术的 65 岁及以上的初级保健提供者(PCP)和患者进行了一项定性研究。我们使用了理论领域框架,为访谈指南和分析提供了信息。

结果

共纳入 16 名参与者(n=8 名提供者,n=8 名患者)。主题包括:1)手术前对药物停用的态度,2)手术前药物停用的预期益处,3)医患关系和共同决策,4)对手术的希望,5)手术前药物停用的障碍,以及 6)对药物停用随访的偏好。

结论

我们关于手术前药物停用的提供者和患者相关障碍和促进因素以及期望过程的研究结果,可能为未来的手术前药物停用干预目标提供信息。

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本文引用的文献

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Patient Educ Couns. 2022 Mar;105(3):615-624. doi: 10.1016/j.pec.2021.06.021. Epub 2021 Jun 24.
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A systematic review of the evidence for deprescribing interventions among older people living with frailty.衰弱老年人药物重整干预措施的证据的系统评价。
BMC Geriatr. 2021 Apr 17;21(1):258. doi: 10.1186/s12877-021-02208-8.
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Barriers and Enablers of Older Patients to Deprescribing of Cardiometabolic Medication: A Focus Group Study.老年患者停用心脏代谢药物的障碍与促进因素:一项焦点小组研究
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Deprescribing for Community-Dwelling Older Adults: a Systematic Review and Meta-analysis.针对社区居住老年人的减药治疗:一项系统评价与荟萃分析。
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Barriers and facilitators to deprescribing in primary care: a systematic review.基层医疗中减药的障碍与促进因素:一项系统综述
BJGP Open. 2020 Aug 25;4(3). doi: 10.3399/bjgpopen20X101096. Print 2020 Aug.
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Development of a hospital deprescribing implementation framework: A focus group study with geriatricians and pharmacists.制定医院减药实施框架:老年病医生和药剂师的焦点小组研究。
Age Ageing. 2019 Dec 1;49(1):102-110. doi: 10.1093/ageing/afz133.
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American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults.美国老年医学学会 2019 年更新的老年人潜在不适当药物使用 AGS Beers 标准®。
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Health Outcomes of Deprescribing Interventions Among Older Residents in Nursing Homes: A Systematic Review and Meta-analysis.养老院老年居民药物减量干预的健康结局:系统评价和荟萃分析。
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Impact of Deprescribing Interventions in Older Hospitalised Patients on Prescribing and Clinical Outcomes: A Systematic Review of Randomised Trials.老年住院患者撤药干预对处方和临床结局的影响:随机试验的系统评价
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