Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, Texas, USA.
Division of Management, Policy, and Community Health, The University of Texas-Houston School of Public Health, University of Texas School of Public Health, Houston, Texas, USA.
J Child Adolesc Psychopharmacol. 2024 Oct;34(8):359-365. doi: 10.1089/cap.2024.0026. Epub 2024 Aug 23.
Professional guidelines recommend that providers routinely monitor children prescribed second-generation antipsychotics (SGA) to reduce the risk of adverse metabolic events associated with the medication. Despite this guidance, many studies show low rates of monitoring compliance. In this study, we interviewed child psychiatrists for their views of possible barriers to monitoring. Semi-structured qualitative interviews, developed according to the Regehr model of influences upon patient-provider decision making, were conducted with child and adolescent psychiatrists in current practice and recruited by convenience and snowball sampling. Interviews were conducted through internet video meetings and were recorded. Interview data were analyzed following Framework Analysis qualitative methods. We recruited and completed interviews with 17 psychiatrists. Patient-level barriers included travel difficulties, limited family time for health care appointments, patient fear of blood draws, and more. Provider-level barriers included professional judgment versus guideline guidance, perceived family burden, assumption of low-risk, short-term SGA use, and more. Organizational level barriers included lack of organizational mandates or incentives, limited appointment time per patient, lack of care coordination, lack of co-located labs, personnel turnover, and more. Barriers at the social and cultural level include stigma and low health literacy. These practicing prescribers provided a wide range of possible barriers to metabolic monitoring in children and adolescents prescribed SGAs. The next step is to explore which may be present in certain settings, and to pilot quality improvement interventions. Addressing barriers can reduce risk of metabolic disorders arising from long-term use of SGAs in children and adolescents.
专业指南建议，医务人员应定期监测服用第二代抗精神病药物（SGA）的儿童，以降低与药物相关的不良代谢事件的风险。尽管有此指南，但许多研究显示监测依从率较低。在这项研究中，我们采访了儿童精神科医生，了解他们对监测可能存在的障碍的看法。
根据 Regehr 影响医患决策模型制定的半结构化定性访谈，对当前执业的儿童和青少年精神科医生进行了访谈，并通过便利抽样和滚雪球抽样进行了招募。访谈通过互联网视频会议进行，并进行了记录。根据框架分析定性方法对访谈数据进行了分析。
我们招募并完成了 17 名精神科医生的访谈。患者层面的障碍包括交通困难、用于医疗预约的家庭时间有限、患者害怕抽血，以及更多。医务人员层面的障碍包括专业判断与指南指导、感知到的家庭负担、假设低风险、短期使用 SGA，以及更多。组织层面的障碍包括缺乏组织授权或激励措施、每位患者的预约时间有限、缺乏护理协调、缺乏相邻实验室、人员流动，以及更多。社会文化层面的障碍包括污名化和健康素养低。
这些执业处方者提供了广泛的可能障碍，以监测服用 SGA 的儿童和青少年的代谢情况。下一步是探索在某些环境中可能存在哪些障碍，并进行质量改进干预的试点。解决这些障碍可以降低儿童和青少年长期使用 SGA 引起代谢紊乱的风险。
