理解澳大利亚普通实践患者在 WiserAD 试验中决定减少抗抑郁药使用的决策：一种基于现实主义的方法。
Understanding Australian general practice patients' decisions to deprescribe antidepressants in the WiserAD trial: a realist informed approach.
机构信息
Department of General Practice and Primary Care, The University of Melbourne, Carlton, Victoria, Australia
Department of General Practice and Primary Care, The University of Melbourne, Carlton, Victoria, Australia.
出版信息
BMJ Open. 2024 Feb 13;14(2):e078179. doi: 10.1136/bmjopen-2023-078179.
OBJECTIVES
To evaluate how an approach to antidepressant deprescribing works, for whom, and in what contexts by (1) examining the experiences and perceptions of the approach for antidepressant users, (2) identifying the mechanisms of the approach and (3) describing what contexts are associated with antidepressant tapering.
DESIGN
This mixed methods study was informed by the principles of realist evaluation and was conducted in the first 3 months of participation in the WiserAD randomised control trial.
SETTING
General practice, Victoria, Australia.
PARTICIPANTS
13 antidepressant users from general practice participating in the WiserAD trial for antidepressant deprescribing.
INTERVENTION
A patient-facing, web-based structured support tool that consists of a personalised tapering schedule, an action plan for managing withdrawal symptoms, a daily mood, sleep and activity tracker and mental health nurse support.
PRIMARY/SECONDARY OUTCOME MEASURES: The outcomes of the study were revealed on data analysis as per a realist evaluation approach which tests and refines an initial programme theory.
RESULTS
The contexts of learnt coping skills, knowledge and perceptions of antidepressants and feeling well were evident. Outcomes were intention to commence, initiation of deprescribing and successful completion of deprescribing. Key mechanisms for antidepressant deprescribing were (1) initiation of the deprescribing discussion; (2) patient self-efficacy; (3) provision of structured guidance; (4) coaching; (5) mood, sleep and activity tracking and (6) feelings of safety during the tapering period.
CONCLUSIONS
The WiserAD approach to antidepressant deprescribing supported participants to commence and/or complete tapering. The refined programme theory presents the WiserAD pragmatic framework for the application of antidepressant deprescribing in clinical practice.
TRIAL REGISTRATION NUMBER
ClinicalTrials.gov NCT05355025; ACTRN12622000567729; ISRCTN11562922; Pre-results.
目的
通过（1）考察该方法对抗抑郁药使用者的经验和看法，（2）确定该方法的机制，（3）描述与抗抑郁药逐渐减少相关的背景，来评估一种抗抑郁药逐渐减少的方法的效果、适用人群和适用背景。
设计
本混合方法研究基于现实主义评价原则，并在参与 WiserAD 随机对照试验的前 3 个月进行。
设置
澳大利亚维多利亚州的一般实践。
参与者
来自一般实践的 13 名参与 WiserAD 试验以减少抗抑郁药的抗抑郁药使用者。
干预措施
面向患者的、基于网络的结构化支持工具，包括个性化的逐渐减少计划、管理戒断症状的行动计划、每日情绪、睡眠和活动追踪以及心理健康护士支持。
主要/次要结果：根据现实主义评价方法，该研究的结果在数据分析中显现，该方法检验和完善了初始方案理论。
结果
习得的应对技能、对抗抑郁药的认识和感觉良好的知识和观念等背景因素明显。结果是开始、开始减少和成功完成减少的意图。抗抑郁药逐渐减少的关键机制包括：（1）开始减少讨论；（2）患者的自我效能；（3）提供结构化指导；（4）辅导；（5）情绪、睡眠和活动跟踪；（6）在减少期间的安全感。
结论
WiserAD 对抗抑郁药逐渐减少的方法支持参与者开始并/或完成减少。经过精炼的方案理论提出了 WiserAD 实用框架，可将抗抑郁药逐渐减少应用于临床实践。
试验注册
ClinicalTrials.gov NCT05355025；ACTRN12622000567729；ISRCTN11562922；预结果。
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