Wind Gitte, Olesen Karen-Marie, Andersen Janne Friis, Hillersdal Line
Department of Nursing and Nutrition, University College Copenhagen, Tagensvej 86, Copenhagen N, 2200, Denmark.
BMC Geriatr. 2025 Jul 2;25(1):451. doi: 10.1186/s12877-025-06059-5.
Adverse drug events represent the largest category of incidents health professionals report to regional authorities in Denmark and remain a significant challenge globally. In connection with these events, it is crucial to focus on a specific vulnerable group: people aged 60 and older with polypharmacy (≥ 5 medicines). Existing research has overlooked the importance for the management process of the intricate interaction between various stakeholders, including patients in their homes, primary care physicians, home care nurses, hospital-based physicians, nurses, pharmacists and pharmacy technicians and community pharmacists. The aim of this article is therefore to explore medication management challenges that emerge in transition and interaction across different health care sectors and between different actors.
This article used an exploratory qualitative design involving focused field visits and open-ended semi-structured interviews with seven patients aged 60 and older; eight home care nurses in two municipalities; three hospital physicians, three hospital nurses, one pharmacist and two pharmacist technicians in one hospital; two primary care physicians from two clinics; and one pharmacist and one pharmacist technician from one pharmacy. Data collection was followed by thematic analysis.
Three themes were identified: clashing medicine that captures the conflicts that arise when different practices, systems, and standards collide across health sectors, blind medicine which highlights the gaps in information flow and communication between healthcare actors, and missing medicine which refers to situations where essential medications are unavailable when needed, whether at home, in the hospital, or at the pharmacy.
This study reveals the intricate nature of medication management and underscores the vital importance of considering the entire medication management process, which involves multiple actors, professional disciplines, electronic systems, physical dispensing systems, and health care sectors. By contributing insights into the practical and systemic nature of medication management challenges, this study aligns with international efforts to address polypharmacy, improve patient-centered care, and strengthen the safety of healthcare delivery.
药物不良事件是丹麦医疗专业人员向地区当局报告的最大类别的事件，并且在全球范围内仍然是一项重大挑战。与这些事件相关的是，关注一个特定的弱势群体至关重要：60岁及以上同时服用多种药物（≥5种药物）的人群。现有研究忽略了包括居家患者、初级保健医生、家庭护理护士、医院医生、护士、药剂师、药房技术员以及社区药剂师在内的各利益相关者之间复杂互动对管理过程的重要性。因此，本文旨在探讨在不同医疗保健部门之间以及不同行为者之间的过渡和互动中出现的药物管理挑战。
本文采用探索性定性设计，包括有针对性的实地考察以及对7名60岁及以上患者、两个市镇的8名家庭护理护士、一家医院的3名医院医生、3名医院护士、1名药剂师和2名药房技术员、两个诊所的2名初级保健医生以及一家药房的1名药剂师和1名药房技术员进行开放式半结构化访谈。数据收集之后进行主题分析。
确定了三个主题：冲突药物，它描述了不同医疗部门之间不同做法、系统和标准发生冲突时出现的矛盾；盲目药物，它突出了医疗行为者之间信息流和沟通方面的差距；缺失药物，它指的是在家庭、医院或药房需要时基本药物无法获得的情况。
本研究揭示了药物管理的复杂性，并强调了考虑整个药物管理过程的至关重要性，这一过程涉及多个行为者、专业学科、电子系统、实体配药系统以及医疗保健部门。通过深入了解药物管理挑战的实际和系统性本质，本研究与应对多重用药、改善以患者为中心的护理以及加强医疗服务安全性的国际努力相一致。
