对于二级护理中低价值处方的退出实施策略的有效性:系统审查
Jennifer Dunsmore1, Eilidh Duncan2, Sara MacLennan3
1Academic Urology Unit, University of Aberdeen, Aberdeen, UK. j.dunsmore.19@abdn.ac.uk.
Implementation science communications
|September 18, 2023
概括
退出实施策略,特别是临床决策支持,可以有效地减少二级护理中不适当的药物处方. 了解临床医生不情愿等障碍是优化这些努力和减少低价值护理的关键.
科学领域:
- 改善医疗保健质量 改善医疗保健质量
- 临床药房 临床药房
- 医疗保健服务研究 医疗服务研究
背景情况:
- 取消实施旨在减少不适当的药物处方和低价值护理.
- 关于二级护理中撤销实施策略的知识有限.
研究的目的:
- 了解二级护理中不适当的药物处方的有效性,障碍,促进者和退出实施策略的后果.
- 为未来的退出实施努力提供信息,以减少低价值护理.
主要方法:
- 2021年2月发布的随机对照试验 (RCT) 的系统审查.
- 在控制试验的CINAHL,EMBASE,MEDLINE和Cochrane注册表中进行了搜索.
- 使用柯克兰偏差风险工具评估偏差风险,并表格化干预特征,有效性,障碍,促进因素和后果.
主要成果:
- 包括11个RCT;七个显示有效的低价值处方的实施.
- 临床决策支持在护理点是最常见和最有效的策略,是低成本和简单.
- 障碍包括临床医生的不情愿和临床环境;教育策略显示出不同的效用. 环境背景,资源和知识是重要的因素.
- 很少有研究衡量了对适当处方的影响.
结论:
- 退出实施策略,特别是临床决策支持,在减少二级护理中不适当的处方方面显示出希望.
- 了解障碍物和促进因素对于成功复制和优化退出实施努力至关重要.
- 进一步的研究应该评估退出对适当护理结果的影响.
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