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Why do family doctors prescribe potentially inappropriate medication to elderly patients?Voigt, Karen, Gottschall, Mandy, Köberlein-Neu, Juliane, Schübel, Jeannine, Quint, Nadine, Bergmann, Antje 06 February 2017 (has links)
Background
Based on changes in pharmacokinetics and –dynamics in elderly patients, there are potentially inappropriate medications (PIM) that should be avoided in patients aged ≥ 65 years. Current studies showed prescription rates of PIM between 22.5 and 28.4 % in the primary care setting. The evidence concerning reasons for PIM prescription by FPs is limited.
Methods
This mixed method study consisted of three research parts: 1) semi-standardized content analysis of patients’ records, 2) qualitative interviews with FPs using a) open questions and b) selected patient-specific case vignettes and 3) qualitative interviews with FPs’ medical assistants. The integration of qualitative interviews was used to explain the quantitative results (triangulation design). PIM were identified according to the German PRISCUS list. Descriptive and multivariate statistical analysis was done using SPSS 22.0. Qualitative content analysis of interviews was used to classify the content of the interviews for indicating pertinent categories. All data were pseudonymously recorded and analyzed.
Results
Content analysis of 1846 patients’ records and interviews with 7 related FPs were conducted. Elderly patients [n = 1241, mean age: 76, females: 56.6 %] were characterized in average by 8.3 documented chronic diagnosis. 23.9 % of elderly patients received at least one PIM prescription. Sedatives/hypnotics were the most frequent prescribed PIM-drugs (13.7 %). Mental disorders, gender and number of long-term medication were detected as predictors for the probability of a PIM prescription. Common reported reasons for PIM prescription by FPs concerned limited knowledge regarding PIM, limited applicability of PIM lists in daily practice, lack of time, having no alternatives in medication, stronger patient-related factors than age that influence prescription, own bad experiences regarding changes of medication or refusal of following prescriptions of sedative/hypnotics.
Conclusions
It is essential to see FPs in a complex decision making situation with several influencing factors on their prescribing, including: patient-oriented prioritization, FPs’ experiences in daily practice, FPs’ knowledge regarding existing recommendations and their trust in it and organizational characteristics of FPs’ daily medical practice. These pros and cons of PIM prescription in elderly patients should be considered in FPs’ advanced training.
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Zdravotně sociální pracovník ve spolupráci s multidisciplinárním týmem při péči o chronicky nemocné dítě / The social worker in healthcare in cooperation with multidisciplinary team in the care of chronically ill childNeradová, Magdaléna January 2021 (has links)
Thesis "The health and social worker in cooperation with a multidisciplinary team in the care of chronically ill children "deals with the verification of the need and importance of multidisciplinary cooperation of the health and social worker with other professionals in the care of chronically ill children. The theoretical part deals with chronic ill children, its impact on the child and the family, describes the function of a health and social worker and other members of a multidisciplinary team with the aim of cooperation within a multidisciplinary team in the care of a chronically ill child. In the practical part, mutual cooperation is verified using the method of qualitative research, interview and case studies. The work is supplemented by a created relationship map of multidisciplinary cooperation in relation to a chronically ill child. Keywords Social worker in healthcare, multidisciplinary team, chronic ill child, hospital, social work, support, family, doctor, psychologist, therapist.
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