Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
BMC Prim Care. 2024 Apr 2;25(1):104. doi: 10.1186/s12875-024-02340-5.
Providing primary care for people with frailty can be challenging due to an increased risk of adverse outcomes and use of potentially inappropriate medications which may exacerbate characteristics of frailty. eConsult is a service where primary care providers can receive timely specialist advice for their patients through a secure web-based application. We aimed to develop a classification system to characterize medication-focused eConsult questions for older adults with frailty and assess its usability.
A classification system was developed and refined over three cycles of improvement through a cross-sectional study of 35 cases categorized as medication-focused from cases submitted in 2019 for patients aged 65 or older with frailty through the Champlain BASE eConsult service (Ontario, Canada). The final classification system was then applied to each case.
The classification system contains 5 sections: (1) case descriptives; (2) intent and type of question; (3) medication recommendations and additional information in the response; (4) medication classification; and (5) potentially inappropriate medications. Among the 35 medication-focused cases, the most common specialties consulted were endocrinology (9 cases, 26%) and cardiology (5 cases, 14%). Medication histories were available for 29 cases (83%). Many patients were prescribed potentially inappropriate medications based on explicit tools (AGS Beers Criteria®, STOPPFall, Anticholinergic Cognitive Burden Scale, ThinkCascades) yet few consults inquired about these medications.
A classification system to describe medication-related eConsult cases for patients experiencing frailty was developed and applied to 35 eConsult cases. It can be applied to more cases to identify professional development opportunities and enhancements for eConsult services.
由于衰弱患者发生不良结局的风险增加，以及潜在不适当药物的使用可能使衰弱的特征恶化，为衰弱患者提供初级保健可能具有挑战性。电子咨询是一种服务，初级保健提供者可以通过安全的基于网络的应用程序及时获得专家对其患者的建议。我们旨在开发一种分类系统来描述针对衰弱的老年患者的以药物为重点的电子咨询问题，并评估其可用性。
通过对 2019 年通过 Champlain BASE 电子咨询服务（加拿大安大略省）提交的 35 例年龄在 65 岁或以上的衰弱患者的药物为重点的病例进行横断面研究，开发并通过三轮改进来完善分类系统。最终的分类系统随后应用于每个病例。
分类系统包含 5 个部分：（1）病例描述；（2）问题的意图和类型；（3）回复中的药物建议和其他信息；（4）药物分类；和（5）潜在不适当的药物。在 35 例以药物为重点的病例中，最常咨询的专科是内分泌科（9 例，26%）和心脏病科（5 例，14%）。有 29 例（83%）提供了药物史。许多患者根据明确的工具（AGS Beers 标准®、STOPPFall、抗胆碱能认知负担量表、ThinkCascades）被开具潜在不适当的药物，但很少有咨询询问这些药物。
开发了一种描述衰弱患者药物相关电子咨询病例的分类系统，并将其应用于 35 例电子咨询病例。可以将更多的病例应用于该分类系统，以确定电子咨询服务的专业发展机会和改进方向。
