CHU Lille, ULR 2694 - METRICS: Evaluation des Technologies de Santé et des Pratiques Médicales, Univ. Lille, Lille, France.
Department of General Practice, University of Lille, Lille, Lille, France.
PLoS One. 2024 Sep 27;19(9):e0309290. doi: 10.1371/journal.pone.0309290. eCollection 2024.
The management of type 2 diabetes mellitus patients has changed over the past decade, and a large number of antidiabetic drug treatment options are now available. This complexity poses challenges for healthcare professionals and may result in potentially inappropriate prescriptions of antidiabetic drugs in patients with type 2 diabetes mellitus which can be limited using screening tools. The effectiveness of explicit tools such as lists of potentially inappropriate prescriptions has been widely demonstrated. The aim was to set up nominal groups of healthcare professionals from several disciplines and develop a list of explicit definition of potentially inappropriate prescriptions of antidiabetic drugs.
In a qualitative, nominal-groups approach, 30 diabetologists, general practitioners, and pharmacists in France developed explicit definitions of potentially inappropriate prescriptions of antidiabetic drugs in patients with type 2 diabetes mellitus. A nominal group technique is a structured method that encourages all the participants to contribute and makes it easier to reach an agreement quickly. Each meeting lasted for two hours.
The three nominal groups comprised 14 pharmacists, 10 diabetologists, and 6 general practitioners and generated 89 explicit definitions. These definitions were subsequently merged and validated by the steering committee and nominal group participants, resulting in 38 validated explicit definitions of potentially inappropriate prescriptions of antidiabetic drugs. The definitions encompassed four contexts: (i) the temporary discontinuation of a medication during acute illness (n = 9; 24%), (ii) dose level adjustments (n = 23; 60%), (iii) inappropriate treatment initiation (n = 3; 8%), and (iv) the need for further monitoring in the management of type 2 diabetes mellitus (n = 3; 8%).
The results of our qualitative study show that it is possible to develop a specific list of explicit definitions of potentially inappropriate prescriptions of antidiabetic drugs in patients with type 2 diabetes mellitus by gathering the opinions of healthcare professionals caring for these patients. This list of 38 explicit definitions necessitates additional confirmation by expert consensus before use in clinical practice.
在过去的十年中，2 型糖尿病患者的管理发生了变化，现在有大量的抗糖尿病药物治疗选择。这种复杂性给医疗保健专业人员带来了挑战，并可能导致 2 型糖尿病患者开出潜在不合适的抗糖尿病药物处方，如果使用筛选工具，这种情况可以得到限制。广泛证明了明确工具（如潜在不适当处方清单）的有效性。目的是建立来自多个学科的医疗保健专业人员的名义小组，并制定明确的潜在不适当抗糖尿病药物处方的定义。
在一项定性的名义小组方法中，来自法国的 30 名糖尿病专家、全科医生和药剂师制定了 2 型糖尿病患者潜在不适当抗糖尿病药物处方的明确定义。名义小组技术是一种结构化方法，鼓励所有参与者做出贡献，并使快速达成一致变得更容易。每次会议持续两个小时。
三个名义小组包括 14 名药剂师、10 名糖尿病专家和 6 名全科医生，提出了 89 条明确的定义。这些定义随后由指导委员会和名义小组参与者合并和验证，产生了 38 条经验证的潜在不适当抗糖尿病药物处方的明确定义。这些定义涵盖了四个方面：（i）急性疾病期间暂时停止用药（9 个；24%）；（ii）剂量水平调整（23 个；60%）；（iii）不合适的治疗开始（3 个；8%）；以及（iv）2 型糖尿病管理中需要进一步监测（3 个；8%）。
我们的定性研究结果表明，通过汇集照顾这些患者的医疗保健专业人员的意见，有可能为 2 型糖尿病患者制定明确的潜在不适当抗糖尿病药物处方的具体清单。在临床实践中使用之前，还需要专家共识进行进一步确认。
