Process evaluation of implementation strategies to reduce potentially inappropriate medication prescribing in older population: A scoping review

ObjectivesSeveral implementation strategies can reduce potentially inappropriate medication (PIM) prescribing. Although use of PIMs has declined in recent years, it remains prevalent. Various strategies exist to improve the appropriateness of medication use. However, little is known about the processes of these different implementation strategies. This scoping review aims to investigate how the process evaluation of implementation strategies for reducing PIM prescribing in the older population has been studied.MethodsWe searched for process evaluations of implementation strategies for reducing PIM prescribing in PUBMED, SCOPUS and Web of Science published between January 2000 and November 2019 in English. We applied the following inclusion criteria: patients aged ≥65 years, validated PIM criteria, and implementation process evaluated. The review focuses on decision support for health care professionals. We described the findings of the process evaluations, and compared the authors’ concepts of process evaluation of the included publications to those of Proctor et al.( 2010).ResultOf 9131 publications screened, 29 met our inclusion criteria. Different process evaluation conceptualizations were identified. Most process evaluations took place in the initial stages of the process (acceptability, adoption, appropriateness, and feasibility) and sustainability and implementation costs were seldom evaluated. None of the included publications evaluated fidelity.Multifaceted interventions were the most studied implementation strategies. Medication review was more common in acceptability evaluations, multidisciplinary interventions in adoption evaluations, and computerized systems and educational interventions in feasibility evaluations. Process evaluations were studied from the health care professionals’ viewpoint in most of the included publications, but the management viewpoint was missing.DiscussionThe conceptualization of process evaluation in the field of PIM prescribing is indeterminate. There is also a current gap in the knowledge of sustainability and implementation costs. Clarifying the conceptualization of implementation process evaluation is essential in order to effectively translate research knowledge into practice.     

某三甲医院门诊预约精准性及其影响因素分析

目的了解某三甲综合医院患者门诊预约精准性及其影响因素,比较正确预约与错误预约患者在预约可及性因素上的差异,寻找提高门诊预约精准性的干预点。方法采用现场调查法,于2021年6月14—21日在四川省成都市某三甲综合医院对70例门诊患者进行面访调查。结果门诊预约精准性低,错误预约患者占36.75%。单因素分析显示,预约精准性正向影响因素包括医疗保险保障度(P=0.004)、线下信息可及度(P=0.049)以及医务人员推荐依从度(P<0.001),负向影响因素包括网络信息依从度(P=0.012)、传统媒体信息可及度(P=0.024)以及自媒体推荐依从度(P<0.001);二分类非条件logistic回归分析显示,预约精准性与听从医务人员推荐正相关(P=0.002),与听从自媒体推荐负相关(P=0.014)。结论医疗机构需要加强宣传力度、丰富宣传内容,提高患者就诊的可及性;建议加强网络及传统媒体虚假医疗信息整治力度能改变门诊患者预约精准性低的现况。     

Building new standards to prevent harm from medication errors in children with cancer

• Children with cancer receive many medications outside the hospital administered by their caregivers.
• The study by Walsh et al. shows the number and types of medication errors in these patients. The study includes data from three different centers.
• Importantly, the study shows the types of errors that cause harm. The authors describe how the harmful errors can be prevented.
• We suggest ways these results can be used to identify which patients and families will benefit from additional attention. Providing more help at clinic and in the home may help prevent harmful medication errors in children with cancer.

     

口腔科门诊应对新型冠状病毒感染防疫探讨

目前新型冠状病毒感染疫情在全国蔓延，疫情防控成为医院工作的重点。口腔科门诊患者人流量大、口腔疾患多、口腔内病菌种类复杂、诊疗过程中患者无法戴口罩、医务人员的手和器械需要接触患者的唾液、血液、病菌等，特别是在相对封闭的环境中长时间暴露于高浓度气溶胶情况下存在经气溶胶传播的可能。本院口腔科门诊通过开诊前准备、就诊期间应急管理、消毒隔离管理等方面细化防疫措施，成果显著，有效保障医患安全。     

清代名医陈念祖“重视气血”治疗月经病用药规律及特点研究

[目的] 探讨研究陈念祖治疗月经病的用药规律及特点。[方法] 收集陈氏《女科要旨》《南雅堂医案》《医学从众录》中治疗月经病的处方81首，构建处方数据库。运用Excel 2010与SPSS Statistics 26.0软件对高频药物进行频数和聚类分析，并结合理论分析，提炼出陈氏治疗月经病的用药规律及特点。[结果] 收集的81首处方中，涉及药物共121味。≥6次的高频药物共32味，使用频数排前3位的是当归、白芍、茯苓。高频药物种类以补血药、补气药为主；四气以温性为首；五味以甘、苦、辛为主；归经以脾经为首，肝经次之，心经再次。聚类分析得出5组核心药组，涉及归脾汤、六君子汤、越鞠丸等方剂。用药特点:使气血化生而调和脾胃，畅气血运行而疏理心肝，守气血循经而调理冲任。[结论] 陈氏治疗月经病以气血为核心，调和脾胃气血、调畅心肝气机、调理冲任气血，多运用补血药、补气药、理气药。     

Medication Adherence App for Food Pantry Clients With Diabetes: A Feasibility Study

Low-income food pantry clients are unable to adhere to the diet and physical activity recommendations of the American Diabetes Association. The aim of the study is to test the feasibility of using a mobile phone app to improve diabetes medication adherence. Clients with uncontrolled type 2 diabetes were enrolled in a mobile phone app featuring 70 days of text message reminders and incentives. The app and the 4-item Morisky Medication Adherence Scale evaluated medication adherence. Clinically significant medication adherence of 93% was achieved with use of the app. Phone app use is feasible among urban low-income clients to improve medication adherence.     

基于二维码的电子诊疗卡系统的设计

目的构建一个以二维码作为电子诊疗卡替代医院传统诊疗卡的系统。方法依托医院微医疗平台,对患者唯一标识和时间戳进行MD5计算生成字符串,并以此内容生成二维码作为电子诊疗卡,同时对HIS进行相应改造,实现电子诊疗卡在全院的应用。结果利用时间戳和MD5签名生成二维码保证了电子诊疗卡加密的唯一性、时效性,医院每年节约成本5万元,患者每次就诊时间减少5 min,提升了患者满意度。结论本文构建的二维码电子诊疗卡系统,解决了使用实体诊疗卡过程中经常出现的忘带卡和重复办卡等问题,提高了医院服务质量,改善了患者就医体验。