对开具第二代抗精神病药物处方的儿童和青少年进行代谢监测:对儿童精神科医生的定性研究。

IF 1.5 4区 医学 Q2 PEDIATRICS
Swarnava Sanyal, Paul J Rowan, Melissa Ochoa-Perez, Chadi Calarge, Rajender Aparasu, Susan Abughosh, Hua Chen
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引用次数: 0

摘要

导言:专业指南建议医疗机构对处方第二代抗精神病药物(SGA)的儿童进行常规监测,以降低与药物相关的不良代谢事件的风险。尽管有这样的指导,但许多研究显示监测的依从性很低。在本研究中,我们采访了儿童精神科医生,了解他们对监测可能存在的障碍的看法。研究方法半结构化定性访谈是根据影响患者-提供者决策的 Regehr 模型制定的,访谈对象是目前正在执业的儿童和青少年精神科医生,通过便利和滚雪球抽样的方式招募。访谈通过互联网视频会议进行,并进行了录音。访谈数据按照框架分析定性方法进行分析。结果:我们招募并完成了对 17 名精神科医生的访谈。患者层面的障碍包括旅行困难、家人看病时间有限、患者害怕抽血等。提供者层面的障碍包括专业判断与指南指导、家庭负担感知、低风险假设、短期使用 SGA 等。组织层面的障碍包括缺乏组织授权或激励措施、每位患者的预约时间有限、缺乏护理协调、缺乏共用实验室、人员流动等。社会和文化层面的障碍包括耻辱感和低健康素养。结论这些执业处方者提供了处方 SGAs 的儿童和青少年在进行代谢监测时可能遇到的各种障碍。下一步是探索在某些情况下可能存在的障碍,并试行质量改进干预措施。消除障碍可降低儿童和青少年因长期服用 SGAs 而出现代谢紊乱的风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Metabolic Monitoring for Children and Adolescents Prescribed Second-Generation Antipsychotics: A Qualitative Study with Child Psychiatrists.

Introduction: Professional guidelines recommend that providers routinely monitor children prescribed second-generation antipsychotics (SGA) to reduce the risk of adverse metabolic events associated with the medication. Despite this guidance, many studies show low rates of monitoring compliance. In this study, we interviewed child psychiatrists for their views of possible barriers to monitoring. Methods: Semi-structured qualitative interviews, developed according to the Regehr model of influences upon patient-provider decision making, were conducted with child and adolescent psychiatrists in current practice and recruited by convenience and snowball sampling. Interviews were conducted through internet video meetings and were recorded. Interview data were analyzed following Framework Analysis qualitative methods. Results: We recruited and completed interviews with 17 psychiatrists. Patient-level barriers included travel difficulties, limited family time for health care appointments, patient fear of blood draws, and more. Provider-level barriers included professional judgment versus guideline guidance, perceived family burden, assumption of low-risk, short-term SGA use, and more. Organizational level barriers included lack of organizational mandates or incentives, limited appointment time per patient, lack of care coordination, lack of co-located labs, personnel turnover, and more. Barriers at the social and cultural level include stigma and low health literacy. Conclusion: These practicing prescribers provided a wide range of possible barriers to metabolic monitoring in children and adolescents prescribed SGAs. The next step is to explore which may be present in certain settings, and to pilot quality improvement interventions. Addressing barriers can reduce risk of metabolic disorders arising from long-term use of SGAs in children and adolescents.

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来源期刊
CiteScore
3.60
自引率
5.30%
发文量
61
审稿时长
>12 weeks
期刊介绍: Journal of Child and Adolescent Psychopharmacology (JCAP) is the premier peer-reviewed journal covering the clinical aspects of treating this patient population with psychotropic medications including side effects and interactions, standard doses, and research on new and existing medications. The Journal includes information on related areas of medical sciences such as advances in developmental pharmacokinetics, developmental neuroscience, metabolism, nutrition, molecular genetics, and more. Journal of Child and Adolescent Psychopharmacology coverage includes: New drugs and treatment strategies including the use of psycho-stimulants, selective serotonin reuptake inhibitors, mood stabilizers, and atypical antipsychotics New developments in the diagnosis and treatment of ADHD, anxiety disorders, schizophrenia, autism spectrum disorders, bipolar disorder, eating disorders, along with other disorders Reports of common and rare Treatment Emergent Adverse Events (TEAEs) including: hyperprolactinemia, galactorrhea, weight gain/loss, metabolic syndrome, dyslipidemia, switching phenomena, sudden death, and the potential increase of suicide. Outcomes research.
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