O'Conor Rachel, Pack Allison, Russell Andrea M, Oladejo Dianne, Rogalski Emily, Morhardt Darby, Fortinsky Richard H, Lindquist Lee A, Persell Stephen D, Wolf Michael S
Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Center for Applied Health Research on Aging, Institute for Public Health and Medicine, Northwestern University, Chicago, IL, USA.
Gerontologist. 2025 Mar 28. doi: 10.1093/geront/gnaf122.
Individuals with mild cognitive impairment (MCI) or dementia work with family caregivers and clinicians to manage multidrug regimens; however, problems with medication management are common and contribute to avoidable hospitalizations among individuals with dementia. We sought to describe the initiation of these triadic clinical encounters and medication management to identify opportunities to enhance them.
We conducted semi-structured qualitative interviews among individuals with MCI or dementia, their family caregivers and primary care clinicians. Clinicians were not required to provide care for enrolled patients. Interview guides were informed by the Triadic Dementia Care Framework. Transcripts were analyzed following the Framework Method.
We enrolled 32 patients, 32 caregivers, and 25 clinicians. Patients, caregivers and clinicians all prioritized patient-focused clinical encounters, and noted transitions in medication management responsibilities typically occur after observing reduced patient capacity. During these transitions, clinicians noted they do not routinely provide an overview of their patients' medications to caregivers, yet caregivers expressed desire for this. Three cross-cutting themes also emerged: 1) balancing patient cognitive impairment limitations and retention of patient autonomy is important to all members of the triad; 2) historical relationship dynamics inform current clinical encounters and medication management; 3) additional time is needed to manage patients with multiple conditions and medications.
Opportunities exist to utilize a multidisciplinary care team to initiate thoughtful early planning for transitions in medication management responsibilities and provide supplemental counseling and materials that reiterate the value of triadic relationships, and detail patient-medication guidance.
轻度认知障碍（MCI）或痴呆患者与家庭照护者及临床医生共同管理多种药物治疗方案；然而，药物管理问题很常见，且会导致痴呆患者出现可避免的住院情况。我们试图描述这些三方临床会诊及药物管理的起始情况，以确定改进的机会。
我们对患有MCI或痴呆的患者、其家庭照护者及初级保健临床医生进行了半结构化定性访谈。临床医生无需为入组患者提供护理。访谈指南参考了三方痴呆照护框架。按照框架法对访谈记录进行了分析。
我们纳入了32名患者、32名照护者和25名临床医生。患者、照护者和临床医生都将以患者为中心的临床会诊列为优先事项，并指出药物管理责任的转变通常发生在观察到患者能力下降之后。在这些转变过程中，临床医生指出他们通常不会向照护者提供患者用药的概述，但照护者表示希望得到这方面的信息。还出现了三个贯穿各领域的主题：1）平衡患者认知障碍的局限性与保留患者自主权对三方所有成员都很重要；2）历史关系动态影响当前的临床会诊和药物管理；3）管理患有多种疾病和服用多种药物的患者需要更多时间。
有机会利用多学科照护团队，对药物管理责任的转变进行深思熟虑的早期规划，并提供补充咨询和材料，重申三方关系的价值，并详细说明患者用药指导。
