Holmqvist Malin, Johansson Linda, Lindenfalk Bertil, Thor Johan, Ros Axel
Department of Public Health and Healthcare, Region Jönköping County, Jönköping, Sweden.
School of Health and Welfare, Jönköping University, Jönköping, Sweden.
JMIR Aging. 2023 Oct 5;6:e49154. doi: 10.2196/49154.
Harm from medications is a major patient safety challenge among older persons. Adverse drug events tend to arise when prescribing or evaluating medications; therefore, interventions targeting these may promote patient safety. Guidelines highlight the value of a joint plan for continued treatment. If such a plan includes medications, a medication plan promoting patient safety is advised. There is growing evidence for the benefits of including patients and health care professionals in initiatives for improving health care products and services through co-design.
This study aimed to identify participants' needs and requirements for a medication plan and explore their reasoning for different design choices.
Using a case study design, we collected and analyzed qualitative and quantitative data and compared them side by side. We explored the needs and requirements for a medication plan expressed by 14 participants (older persons, nurses, and physicians) during a co-design initiative in a regional health system in Sweden. We performed a directed content analysis of qualitative data gathered from co-design sessions and interviews. Descriptive statistics were used to analyze the quantitative data from survey answers.
A medication plan must provide an added everyday value related to safety, effort, and engagement. The physicians addressed challenges in setting aside time to apply a medication plan, whereas the older persons raised the potential for increased patient involvement. According to the participants, a medication plan needs to support communication, continuity, and interaction. The nurses specifically addressed the need for a plan that was easy to gain an overview of. Important function requirements included providing instant access, automation, and attention. Content requirements included providing detailed information about the medication treatment. Having the plan linked to the medication list and instantly obtainable information was also requested.
After discussing the needs and requirements for a medication plan, the participants agreed on an iteratively developed medication plan prototype linked to the medication list within the existing electronic health record. According to the participants, the medication plan prototype may promote patient safety and enable patient engagement, but concerns were raised about its use in daily clinical practice. The last step in the co-design framework is testing the intervention to explore how it works and connects with users. Therefore, testing the medication plan prototype in clinical practice would be a future step.
药物危害是老年人患者安全面临的一项重大挑战。不良药物事件往往在开药或评估药物时出现；因此，针对这些环节的干预措施可能会促进患者安全。指南强调了持续治疗联合计划的价值。如果这样的计划包含药物，建议制定一个促进患者安全的药物计划。越来越多的证据表明，让患者和医护人员通过共同设计参与改善医疗产品和服务的举措具有诸多益处。
本研究旨在确定参与者对药物计划的需求和要求，并探讨他们对不同设计选择的理由。
采用案例研究设计，我们收集并分析了定性和定量数据，并将它们并列比较。我们探讨了瑞典一个区域卫生系统在共同设计倡议期间，14名参与者（老年人、护士和医生）对药物计划表达的需求和要求。我们对从共同设计会议和访谈中收集的定性数据进行了定向内容分析。描述性统计用于分析调查答案中的定量数据。
药物计划必须提供与安全性、便利性和参与度相关的日常附加价值。医生们谈到了留出时间应用药物计划方面的挑战，而老年人则提出了增加患者参与度的可能性。据参与者称，药物计划需要支持沟通、连续性和互动。护士们特别提到需要一个易于全面了解的计划。重要的功能要求包括提供即时访问、自动化和提醒。内容要求包括提供有关药物治疗的详细信息。还要求该计划与药物清单相关联且信息可即时获取。
在讨论了药物计划的需求和要求后，参与者们就一个与现有电子健康记录中的药物清单相关联、经过迭代开发的药物计划原型达成了一致。据参与者称，该药物计划原型可能会促进患者安全并使患者能够参与其中，但也有人对其在日常临床实践中的使用表示担忧。共同设计框架的最后一步是测试干预措施，以探索其工作方式以及与用户的联系。因此，在临床实践中测试该药物计划原型将是未来的一个步骤。
