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加强老年人初级保健:基于安全、疗效和依从性(SEA)团队的护理模式以减少药物不良后果。

Enhancing primary care for older adults: the safety, efficacy, and adherence (SEA) team-based care model to reduce adverse medication outcomes.

作者信息

Changaris Michael

机构信息

Integrated Health Psychology Training Program, The Wright Institute, Berkeley, CA, United States.

Doctor of Psychology Program, University of San Francisco, San Francisco, CA, United States.

出版信息

Front Public Health. 2025 Aug 6;13:1453485. doi: 10.3389/fpubh.2025.1453485. eCollection 2025.


DOI:10.3389/fpubh.2025.1453485
PMID:40843417
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12364638/
Abstract

INTRODUCTION: Older adults face significant health risks owing to gaps in the management of polypharmacy and medication adherence, as well as the integration of physical and mental health needs. Current models do not fully address these challenges. This study introduced the Safety, Efficacy, and Adherence (SEA) model designed to enhance interdisciplinary collaboration, improve medication management, and integrate care for older adults. This model addresses the core drivers of poor health outcomes: (1) medication adherence challenges, (2) social determinants of health, (3) polypharmacy, (4) team-based care with family support for deprescribing, and (5) psychosocial factors related to aging. METHODS: The SEA model was developed through a structured literature review focusing on medication safety, polypharmacy, behavioral health integration, home safety inspections and adherence. It draws on frameworks such as the Chronic Care Model, Interprofessional Collaborative Care for Older Adults, and Consolidated Framework for Implementation Research. This model fosters interdisciplinary collaboration by integrating pharmacists, primary care providers, mental health professionals, substance use treatment, and family suppowrt, and it is adaptable to diverse clinical settings. RESULTS: The SEA model assessed short- and long-term outcomes. Potential short-term effects included improved medication adherence, enhanced team coordination, and reduced occurrence of adverse drug events. Long-term goals and possible effects included better chronic disease management, fewer hospitalizations, and improved quality of life for older adults. The model's scalability allows for application across various healthcare settings, although further testing is required for validation. CONCLUSION: The SEA model provides a comprehensive framework for addressing the complex needs of older adults by focusing on medication SEA. Two vignettes, one clinical and one organizational, demonstrate the practical application of the model in patient care and implementation science. By improving interdisciplinary collaboration and addressing social and behavioral factors, in home safety for medications, this model aims to reduce polypharmacy and hospitalization. Based on existing evidence-based frameworks, this model would benefit from future studies to validate its effectiveness in diverse settings.

摘要

引言:由于多重用药管理和药物依从性方面存在差距,以及身心健康需求的整合问题,老年人面临重大健康风险。当前模式未能充分应对这些挑战。本研究引入了安全、疗效与依从性(SEA)模型,旨在加强跨学科协作、改善药物管理并整合老年人护理。该模型解决了健康不良结果的核心驱动因素:(1)药物依从性挑战;(2)健康的社会决定因素;(3)多重用药;(4)有家庭支持的团队式减药护理;(5)与衰老相关的心理社会因素。 方法:SEA模型是通过聚焦药物安全、多重用药、行为健康整合、家庭安全检查和依从性的结构化文献综述而开发的。它借鉴了诸如慢性病护理模型、老年人跨专业协作护理以及实施研究综合框架等框架。该模型通过整合药剂师、初级保健提供者、心理健康专业人员、药物使用治疗人员和家庭支持来促进跨学科协作,并且适用于各种临床环境。 结果:SEA模型评估了短期和长期结果。潜在的短期影响包括提高药物依从性、加强团队协调以及减少药物不良事件的发生。长期目标和可能的影响包括更好地管理慢性病、减少住院次数以及改善老年人的生活质量。该模型的可扩展性使其能够应用于各种医疗环境,不过需要进一步测试以进行验证。 结论:SEA模型通过关注药物SEA为满足老年人的复杂需求提供了一个综合框架。两个案例,一个是临床案例,一个是组织案例,展示了该模型在患者护理和实施科学中的实际应用。通过改善跨学科协作并解决社会和行为因素,以及家庭用药安全问题,该模型旨在减少多重用药和住院率。基于现有的循证框架,该模型将受益于未来研究以验证其在不同环境中的有效性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6733/12364638/d33794629d47/fpubh-13-1453485-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6733/12364638/db76d0acb21e/fpubh-13-1453485-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6733/12364638/c7c88e69041b/fpubh-13-1453485-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6733/12364638/2b8c1ce2c09b/fpubh-13-1453485-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6733/12364638/96bf295897b9/fpubh-13-1453485-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6733/12364638/d33794629d47/fpubh-13-1453485-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6733/12364638/db76d0acb21e/fpubh-13-1453485-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6733/12364638/c7c88e69041b/fpubh-13-1453485-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6733/12364638/2b8c1ce2c09b/fpubh-13-1453485-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6733/12364638/96bf295897b9/fpubh-13-1453485-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6733/12364638/d33794629d47/fpubh-13-1453485-g005.jpg

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本文引用的文献

[1]
Assessing the Efficacy of the ARMOR Tool-Based Deprescribing Intervention for Fall Risk Reduction in Older Patients Taking Fall Risk-Increasing Drugs (DeFRID Trial): Protocol for a Randomized Controlled Trial.

JMIR Res Protoc. 2024-6-11

[2]
The influence of patients' beliefs about medicines and the relationship with suboptimal medicine use in community-dwelling older adults: a systematic review of quantitative studies.

Int J Clin Pharm. 2024-8

[3]
Interventions to promote health literacy among working-age populations experiencing socioeconomic disadvantage: systematic review.

Front Public Health. 2024

[4]
Using Academic Detailing to Enhance the Knowledge, Skills, and Attitudes of Clinicians Caring for Persons with Behavioral and Psychological Symptoms of Dementia.

J Am Med Dir Assoc. 2023-12

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An Integrated Patient-Centred Medical Home (PCMH) Care Model Reduces Prospective Healthcare Utilisation for Community-Dwelling Older Adults with Complex Needs: A Matched Observational Study in Singapore.

Int J Environ Res Public Health. 2023-9-27

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BMC Geriatr. 2023-9-25

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Utilizing Social Determinants of Health Model to Understand Barriers to Medication Adherence in Patients with Ischemic Stroke: A Systematic Review.

Patient Prefer Adherence. 2023-8-30

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Patient. 2023-11

[9]
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Glob Health Res Policy. 2023-7-12

[10]
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Implement Res Pract. 2020-10-7

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