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首页> 外文期刊>BMC Family Practice >Factors influencing deprescribing for residents in Advanced Care Facilities: insights from General Practitioners in Australia and Sweden
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Factors influencing deprescribing for residents in Advanced Care Facilities: insights from General Practitioners in Australia and Sweden

机译：影响高级护理机构居民开处方的因素：澳大利亚和瑞典全科医生的见解

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Background General Practitioners (GPs) are responsible for primary prescribing decisions in most settings. Elderly patients living in Advanced Care Facilities (ACFs) often have significant co-morbidities to consider when selecting an appropriate drug therapy. Careful assessment is required when considering appropriate medication use in frail older patients as they have multiple diseases and thus multiple medication. Many physicians seem reluctant to discontinue other physicians’ prescriptions, resulting in further polypharmacy. Therefore it is relevant to ascertain and synthesise the GP views from multiple settings to understand the processes that might promote appropriate deprescribing medications in the elderly. The aims of this study were to 1) compare and contrast behavioural factors influencing the deprescribing practices of GPs providing care for ACF residents in two separate countries, 2) review health policy and ACF systems in each setting for their potential impact on the prescribing of medications for an older person in residential care of the elderly, and 3) based on these findings, provide recommendations for future ACF deprescribing initiatives. Methods A review and critical synthesis of qualitative data from two interview studies of knowledge, attitudes, and behavioural practices held by GPs towards medication management and deprescribing for residents of ACFs in Australia and Sweden was conducted. A review of policies and health care infrastructure was also carried out to describe the system of residential aged care in the both countries. Results Our study has identified that deprescribing by GPs in ACFs is a complex process and that there are numerous barriers to medication reduction for aged care residents in both countries, both with similarities and differences. The factors affecting deprescribing behaviour were identified and divided into: intentions, skills and abilities and environmental factors. Conclusions In this study we show that the GPs’ behaviour of deprescribing in two different countries is much dependent on the larger health care system. There is a need for more education to both GPs and ACF staff as well as better cooperation between the different health care systems and appropriate monetary incentives for elderly care to achieve better conditions for deprescribing practice.
机译：背景全科医师（GP）在大多数情况下负责主要的处方决策。住在高级护理机构（ACF）中的老年患者在选择适当的药物治疗时通常要考虑很多合并症。在体弱的老年患者中考虑合理用药时，需要仔细评估，因为他们有多种疾病，因此有多种药物。许多医生似乎不愿停止其他医生的处方，从而导致了更多的多药房。因此，有必要从多个设置中确定和综合GP的观点，以了解可能促进老年人使用适当处方药的过程。这项研究的目的是：1）比较和对比影响在两个不同国家/地区为ACF居民提供护理的全科医生的处方实践的行为因素，2）在每种情况下均审查健康政策和ACF系统对处方药的潜在影响3）基于这些发现，为将来的ACF淘汰计划提供建议。方法对澳大利亚和瑞典的全科医师针对药物管理和ACF居民处方开具的知识，态度和行为实践进行的两次访谈研究，对质量数据进行了回顾和批判性综合。还对政策和医疗保健基础设施进行了审查，以描述两国的养老院系统。结果我们的研究发现，在ACF中由GP进行处方处方是一个复杂的过程，并且两国的老年护理居民在减少用药方面存在许多障碍，既有相似之处，也有不同之处。确定影响预定行为的因素，并将其分为：意图，技能和能力以及环境因素。结论在这项研究中，我们表明全科医生在两个不同国家开处方的行为在很大程度上取决于更大的医疗体系。有必要对全科医生和ACF工作人员进行更多的教育，以及不同卫生保健系统之间的更好合作，并为老年人护理提供适当的金钱激励，以达到更好的开办处方的条件。

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