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背景对于多重用药老年患者,用药管理是一个精心考虑的过程,需要根据治疗效果和变化情况定期调整。由于患者间的异质性以及当前指南适用性有限,所以全科医生很难建立一个用药管理体系。目的深入了解全科医生针对多重用药老年患者的用药管理策略,探讨在促进用药管理上全科医生的视角和决策。设计与场所两个焦点小组与荷兰全科医生会面,讨论患病率多发和多重用药患者的4个临床场景。方法单独回答临床场景的用药管理问题;会议上全体讨论每种案例的选择策略,采用结构法进行分析。结果共12例全科医生描述了关于患者用药管理的类似策略:确定治疗目标,确定主要目标,基于治疗效果调整用药,全科医生和患者的偏好及患者的特征。全科医生之间在执行该策略时存在不同。全科医生乐于与其他专业人士讨论其选择,重视与患者回顾结构化用药以及工作所需的快速、实用的支持工具。结论为了便于决策,医疗专业人士之间需要更广泛的、结构化的合作,与患者进行结构化用药回顾。
Background For multi-drugged elderly patients, medication administration is a well-thought-out process and needs to be regularly adjusted to the effect and changing circumstances of the treatment. Because of the heterogeneity among patients and the limited applicability of the current guidelines, GPs find it difficult to establish a medication management system. Objectives To gain insight into general practitioners’ medication management strategies for elderly patients with multiple drugs and to explore general practitioner perspectives and decision-making in promoting drug administration. Two Focus Groups of Design and Locations met with Dutch GPs to discuss four clinical scenarios in patients with multiple prevalence and multiple drug use. Methods A single answer to the clinical management of drug use cases; the meeting discussed the selection strategy of each case, the use of structural analysis. Results A total of 12 GPs described a similar strategy for patient medication management: setting treatment goals, setting key goals, adjusting medication based on treatment effects, general practitioner and patient preferences, and patient characteristics. There is a difference between general practitioners in implementing this strategy. General practitioners are happy to discuss their options with other professionals and value quick and practical support tools for reviewing structured medication and the work required of patients. Conclusion In order to facilitate decision-making, there is a need for broader and structured cooperation among medical professionals to review structured treatment with patients.