Lebrat Matthieu, Megard Rachel, Gallo Blandin Anne-Cecile, Franck Nicolas, Zimmer Luc
Pôle Centre Rive Gauche, Centre Hospitalier Le Vinatier, Lyon, France.
Hospices Civils de Lyon, Lyon, France.
J Multidiscip Healthc. 2024 Dec 17;17:6017-6030. doi: 10.2147/JMDH.S481398. eCollection 2024.
Psychopharmacology prescriptions are complex, partly due to the complexity of the relationship between diagnosis and its etiology, as well as the iatrogenic impact on symptomatology. Many multidisciplinary tools exist to optimize their management and improve evidence-based practice. However, their multidisciplinary integration seems to be a challenge. This study aimed to collect information on barriers and facilitators perceived by hospital health professionals regarding the use of multidisciplinary tools to address complex situations in psychopharmacology.
A mixed-methods research approach using semi-structured interviews was conducted with physicians and pharmacists from 11 hospital institutions. An interview guide developed from the COM-B model (Capability, Opportunity, and Motivation - Behavior) was used to identify barriers and facilitators to the use of multidisciplinary tools. Data were analyzed using thematic analysis to identify emerging themes and mapped to the COM-B model.
28 professionals were interviewed. Identified barriers were: lack of knowledge and time to address complex situations, incomplete medical records, lack of easily accessible multidisciplinary tools, insufficient levels of evidence in psychopharmacology. Identified facilitators were: continuing education, communication and networking among professionals, implementation of adapted and shared resources, deprescribing, awareness of medication-induced iatrogenesis, accessibility of tools for all populations.
Identified barriers and facilitators in the use of multidisciplinary tools for complex situations in psychopharmacology helped to model factors that enable behavior change. Answers need to be provided to help professionals ensure and optimize psychopharmacological therapies.
精神药理学处方很复杂，部分原因在于诊断与其病因之间关系的复杂性，以及对症状学的医源性影响。存在许多多学科工具来优化其管理并改善循证实践。然而，它们的多学科整合似乎是一项挑战。本研究旨在收集医院卫生专业人员在使用多学科工具处理精神药理学复杂情况方面所感知到的障碍和促进因素的信息。
采用混合方法研究，对来自11家医院机构的医生和药剂师进行半结构化访谈。使用从COM-B模型（能力、机会和动机 - 行为）开发的访谈指南来识别使用多学科工具的障碍和促进因素。使用主题分析对数据进行分析，以识别新出现的主题，并映射到COM-B模型。
采访了28名专业人员。识别出的障碍包括：缺乏处理复杂情况的知识和时间、病历不完整、缺乏易于获取的多学科工具、精神药理学证据水平不足。识别出的促进因素包括：继续教育、专业人员之间的沟通和网络、实施适配和共享的资源、减药、对药物引起的医源性疾病的认识、工具对所有人群的可及性。
在精神药理学复杂情况中使用多学科工具时识别出的障碍和促进因素有助于构建促成行为改变的因素模型。需要提供答案以帮助专业人员确保并优化精神药理学治疗。
