第三次的魅力:加强全球努力,减少与药物有关的伤害

IF 0.6 Q4 HEALTH CARE SCIENCES & SERVICES
A. Wu, A. Mair, I. Papieva, Ayda Taha, Neelam Dhingra
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引用次数: 0

摘要

我每天开始服用同样的药物:一种降胆固醇药治疗家族性高脂血症,一种质子泵抑制剂治疗胃肠道反流,一种非处方抗组胺药治疗慢性过敏。(AW)我并不例外。超过一半的美国成年人每天服用两片或更多的药片,近一半的人每周服用三种处方药,这让我正好处于中间位置。在全球范围内,这一数字略低,但具有可比性。对于老年人来说,这个数字更大:美国五分之三的老年人每天服用五种或更多的处方。处方药帮助世界各地的人们治疗疾病,但如果过度使用、使用不足、不加以监测或以其他方式滥用,它们也会造成伤害。自患者安全时代开始以来,不安全的用药做法和用药错误一直是全球卫生保健系统中造成伤害和可避免伤害的主要原因。但大多数人,大多数时候,都没有意识到药物使用的潜在负面影响。服用多种药物的需求也可能同样成问题,导致频繁的医疗联系和药物相关伤害的可能性增加。这些风险在特定情况下以及在不同层次、地点和护理环境的过渡点会扩散。在错综复杂的用药系统中,用药错误无处不在。其核心是处方、订购、储存、调剂、制备、管理和监测实践。用药错误是多方面的,可能由于薄弱的用药系统和做法而发生,这些系统和做法面临着越来越多的药物、给药途径和配方、人为因素、使用的复杂性和更广泛的系统问题。在许多情况下,不安全的用药做法可导致严重伤害、残疾甚至死亡。尽管已经制定了无数的策略来解决药物错误的频率和影响,但它们的实施却各不相同。我们认为,患者和家属可以在安全有效地服用药物方面发挥关键作用。医疗保健专业人员需要确保患者有权这样做。2019冠状病毒病大流行凸显了许多药物使用不当的领域。有些药物没有得到科学研究的支持,如伊维菌素和羟氯喹,并造成了重大危害。有明显的抗生素处方不当的例子。超过70%的COVID-19病例使用了抗生素,通常是因为怀疑在一个系列中存在细菌重复感染,而在超过三分之一的病例中,抗生素被认为是不合适的。有许多病例与使用补充和替代药物有关,尽管证明其有效性的证据有限,但仍然使用这些药物。此外,大流行造成的卫生保健系统中断导致更频繁的自我保健行为,这也对药物安全产生影响。还有许多其他不当用药的例子,这是增加伤害风险的同义词。例如,治疗非传染性疾病的药物没有得到审查,特别是治疗焦虑和抑郁的药物没有得到审查或监测。认识到与不安全用药做法相关的可避免伤害的规模,世卫组织于2017年在德国波恩发起了第三项全球患者安全挑战:无伤害用药。《应对挑战战略框架》要求采取系统性方法解决用药安全问题,涉及四个关键领域:患者和公众、卫生保健专业人员、药物和系统以及用药实践。作为挑战的一部分,世卫组织已要求世界各地的主要利益攸关方在与不安全用药做法对患者造成重大伤害相关的三个关键领域优先考虑并尽早采取行动:
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Third Time’s the Charm: Strengthening Global Efforts to Reduce Medication-Related Harm
I begin every day taking the same pill regimen: a cholesterol-lowering agent for familial hyperlipidemia, a proton-pump inhibitor for gastrointestinal reflux, and an over-the-counter antihistamine for chronic allergies. (AW) I am not exceptional. Over half of US adults take two or more pills a day, and nearly half take three prescription medications a week, putting me squarely in the middle of the road. Worldwide, numbers are slightly lower but comparable. For older adults the numbers are greater: three out of five older adults in the US take five or more prescriptions a day. Prescription medications help people around the world treat medical conditions, but they can also cause harm if overused, underused, not monitored, or otherwise misused. Since the beginning of the patient safety era, unsafe medication practices and medication errors have been the leading cause of injury and avoidable harm in health care systems across the globe. But most people, most of the time, fail to appreciate the potential downsides of medication use. The need to take multiple medications can be just as problematic, resulting in frequent health care contacts and an increased likelihood of medication related harm. These risks proliferate in specific situations, and at transition points at different levels, locations, and settings of care. Medication errors occur at every point in the labyrinthine medication use system. At the center lie prescribing, ordering, storage, dispensing, preparation, administration, and monitoring practices. Medication errors are multidimensional and may occur because of the weak medication systems and practices, which face increasing numbers of medications, routes of delivery and formulations, human factors, complexity of use, and broader system issues. In many cases, unsafe medication practices can result in severe harm, disability and even death. Although countless strategies have been developed to address the frequency and impact of medication errors, their implementation has been variable. We assert that patients and families can play a key role in taking medications safely and effectively. Healthcare professionals need to ensure that patients are empowered to do this. The COVID-19 pandemic highlighted many areas where medications were used inappropriately. Some were not supported by scientific studies, such as ivermectin and hydroxchloroquine, and caused significant harms. There were conspicuous examples of inappropriate antibiotic prescribing. Antibiotic use has been described in more than 70% of cases of COVID-19, often for the suspicion of bacterial superinfection in one series this was judged inappropriate in over a third. There were many cases related to the use of complementary and alternative medicines, used despite limited evidence for their effectiveness. Moreover, the disruptions in the health care systems caused by the pandemic resulted in more frequent self-care practices, which also has implications for medication safety. There were many other examples of inappropriate medication use, which is synonymous with increased risk of harm. For example, medications for non-communicable disease were not reviewed In particular, medications for anxiety and depression were used without review or monitoring. Recognizing the scale of avoidable harm linked with unsafe medication practices, the third WHO Global Patient Safety Challenge: Medication Without Harm was launched in Bonn, Germany in 2017. The Strategic Framework of the Challenge calls for a systemic approach to address medication safety, by acting across four key domains: patients and the public, health care professionals, medicines and systems and practices of medication. As part of the Challenge, WHO has asked key stakeholders worldwide to prioritize and take early action in three key areas associated with significant patient harm due to unsafe medication practices:
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