儿科复杂护理项目中儿科多药管理的挑战:定性试点研究

IF 2.5 4区 医学 Q3 PHARMACOLOGY & PHARMACY
Julia Reedy, Talia Thompson, Anowara Begum, Megan A. Morris, Allison Kempe, Chris Feudtner, Mark Gritz, James A. Feinstein
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引用次数: 0

摘要

背景:小儿多药治疗对于患有医学复杂性(CMC)的儿童的症状和疾病管理通常是必要的,但可能导致药物相关问题。关于儿科护理团队如何协调努力管理多种药物,人们知之甚少。这限制了干预措施的实用设计,以全面管理儿科综合用药。目的:在CMC的一个大型门诊儿科综合护理项目中,我们试图了解1)如何由多学科团队管理儿科综合用药,2)相关挑战,以及3)改进的机会。方法:我们进行了定性试点研究儿科临床医生的处方和非处方的角色。主题内容分析用于综合参与者的调查结果并确定关键主题。结果:我们采访了16名临床医生,分别代表处方医生(n=9)和非处方医生(n=7)。出现了三个总体主题:1)儿童综合用药存在独特的安全风险;2)综合药房管理需要不同临床角色之间的密切合作,以完成大量与药物相关的任务;3)跨亚专科的多个开处方者使综合药房管理复杂化,包括在确定某些药物的责任方面面临挑战。临床医生描述了医疗保健系统(患者、诊所、医院和系统)不同层面的无数挑战,并赞同需要儿科药剂师来帮助减轻这些挑战。结论:管理CMC的儿科综合用药的干预措施将需要一个多层次的方法,包括1)管理可访问的高度集中的药物文件,2)基于临床专业知识的某些药物相关任务的授权,以及3)协调医疗机构和护理环境的药物管理活动。综合儿科药师支持可以解决许多这些需求。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Challenges of managing pediatric polypharmacy in a pediatric complex care program: A qualitative pilot study

Background

Pediatric polypharmacy is often necessary for symptom and disease management in children with medical complexity (CMC) but can result in medication-related problems. Little is known about how pediatric care teams coordinate efforts to manage polypharmacy. This limits the pragmatic design of interventions to comprehensively manage pediatric polypharmacy.

Objectives

In a large outpatient pediatric complex care program for CMC, we sought to understand 1) how pediatric polypharmacy is managed by a multidisciplinary team, 2) associated challenges, and 3) opportunities for improvement.

Methods

We conducted a qualitative pilot study of pediatric clinicians with prescribing and nonprescribing roles. Thematic content analysis was used to synthesize findings across participants and identify key themes.

Results

We interviewed 16 clinicians representing prescribing (n = 9) and nonprescribing (n = 7) clinicians. Three of the following overarching themes emerged: 1) pediatric polypharmacy poses unique safety risks for CMC; 2) polypharmacy management requires careful collaboration between distinct clinical roles to accomplish numerous medication-related tasks; and 3) multiple prescribers across subspecialties complicates polypharmacy management, including challenges in identifying responsibility for certain medications. Clinicians described myriad challenges across different levels of the healthcare system (patient, clinic, hospital, and system) and endorsed the need for a pediatric pharmacist to help mitigate these challenges.

Conclusion

Interventions to manage pediatric polypharmacy for CMC will require a multilevel approach including the 1) curation of accessible highly centralized medication documentation, 2) delegation of certain medication-related tasks based on clinical expertise, and 3) coordination of medication management activities across health care organizations and settings of care. Integrated pediatric pharmacist support could address many of these needs.
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来源期刊
CiteScore
3.30
自引率
14.30%
发文量
336
审稿时长
46 days
期刊介绍: The Journal of the American Pharmacists Association is the official peer-reviewed journal of the American Pharmacists Association (APhA), providing information on pharmaceutical care, drug therapy, diseases and other health issues, trends in pharmacy practice and therapeutics, informed opinion, and original research. JAPhA publishes original research, reviews, experiences, and opinion articles that link science to contemporary pharmacy practice to improve patient care.
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