Chang Chee Tao, Chan Huan-Keat, Liew Ewilly Jie Ying, Abu Hassan Muhammad Radzi, Lee Jason Choong Yin, Cheah Wee Kooi, Lim Xin Jie, Rajan Philip, Teoh Siew Li, Lee Shaun Wen Huey
School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia.
Clinical Research Centre Hospital Raja Permaisuri Bainun, Institute for Clinical Research, National Institute of Health, Ministry of Health Malaysia, Ipoh, Malaysia.
J Pharm Policy Pract. 2024 Sep 16;17(1):2399727. doi: 10.1080/20523211.2024.2399727. eCollection 2024.
Deprescribing serves as a pivotal measure to mitigate the drug-related problem due to polypharmacy. This study aimed to map the factors influencing healthcare providers' deprescribing decision using the Behaviour Change Wheel framework and develop an innovative conceptual model to support deprescribing practice.
A cross-sectional online survey targeting doctors and pharmacists was conducted to assess the influence of various factors on healthcare providers' comfort in recommending deprescribing. The conceptual model was formulated, based on the existing deprescribing framework and the Behaviour Change Wheel. The model's robustness was scrutinised through Partial Least Squares Structural Equation Modeling (PLS-SEM), and model-fitting indices were employed to obtain the best-fit model.
A total of 736 responses were analysed with the final best-fit model consisting of 24 items in 5 constructs ( : 0.163; SRMR: 0.064; rho_c: 0.750-0.862; AVE: 0.509-0.627) and three independent factors. Based on the results, we proposed that deprescribing could be promoted through strategies aimed at enhancing healthcare providers internal capabilities such as knowledge levels, when patients' condition deteriorated and previous experiences with adverse events of drugs. Organisational support in providing such educational opportunities is important, with the empowerment of patient and healthcare providers through policy enhancements, guideline development, and effective communication.
The deprescribing behaviours of healthcare professionals are influenced by an intricate interplay of patient, prescriber, and system factors. Enhancing deprescribing practices necessitates a comprehensive strategy that encompasses providers and patients' education, the development of structured deprescribing guidelines, the implementation of deprescribing support tools, and the enhancement of communication between healthcare providers.
减药是缓解多重用药所致药物相关问题的关键措施。本研究旨在运用行为改变轮框架梳理影响医护人员减药决策的因素，并构建一个创新的概念模型以支持减药实践。
针对医生和药剂师开展了一项横断面在线调查，以评估各种因素对医护人员推荐减药时舒适度的影响。基于现有的减药框架和行为改变轮制定了概念模型。通过偏最小二乘结构方程模型（PLS-SEM）对模型的稳健性进行了审查，并使用模型拟合指标来获得最佳拟合模型。
共分析了736份回复，最终的最佳拟合模型由5个结构中的24个项目组成（：0.163；SRMR：0.064；rho_c：0.750 - 0.862；AVE：0.509 - 0.627）以及三个独立因素。基于这些结果，我们提出可以通过旨在提高医护人员内部能力（如知识水平）的策略来促进减药，这些策略适用于患者病情恶化以及既往有药物不良事件经历的情况。组织在提供此类教育机会方面的支持很重要，同时通过政策强化、指南制定和有效沟通来增强患者和医护人员的能力。
医护专业人员的减药行为受到患者、开处方者和系统因素复杂相互作用的影响。加强减药实践需要一项全面的策略，包括对医护人员和患者的教育、制定结构化的减药指南、实施减药支持工具以及加强医护人员之间的沟通。
