4 | 0 | 6 |
下载次数 | 被引频次 | 阅读次数 |
目的 构建老年人便秘非处方药物应用清单,为临床规范指导老年人合理用药提供循证依据。方法 基于国际“明智选择”运动构建低价值护理清单的方法,通过文献系统回顾形成初步清单,采用专家会议法对条目进行优化调整,确定清单内容,并在临床科室中进行初步应用。结果 老年人便秘非处方药物应用清单包括药物选择和药物应用两部分,确定了用药时机、梯度用药、分类用药、个性化用药、用药方法、用药指导6个主题,共16个条目。清单初步应用降低了老年人便秘非处方药物应用的不适当行为,提升了护士对低价值护理的知晓率。结论 构建的老年人便秘非处方药物应用清单具有较好的科学性、实用性,可为医护人员提供有效的便秘用药管理工具。
Abstract:Objective To construct a checklist for over-the-counter medication use in elderly patients with constipation and provide an evidence-based tool for standardized clinical guidance on rational medication use.Methods Based on the methodology of constructing low value-care lists from the international "Choosing Wisely" campaign, a preliminary checklist was developed through systematic literature review.The expert panel meeting method was used to refine and adjust the items, finalizing the checklist content, then the checklist was preliminarily applied in clinical departments.Results The finalized checklist comprises two modules of medication selection and application, it covered 6 themes: timing of medication initiation, stepwise therapy, medication classification, personalized use, administration methods and medication guidance, total 16 items.The application of the list reduced inappropriate over-the-counter medication use in elderly patients with constipation, improved nurses' awareness of low value-care.Conclusion The checklist for over-the-counter medication using of elderly patients with constipation developed in the study demonstrates sound scientific validity and clinical utility, it provides healthcare professionals with an effective tool for optimizing constipation pharmacotherapy management.
[1] CHEN Z,PENG Y,SHI Q,et al.Prevalence and risk factors of functional constipation according to the Rome criteria in China:a systematic review and Meta-analysis[J].Frontiers in Medicine,2022,9:815156.DOI:10.3389/fmed.2022.815156.
[2] GUSTAFSSON M,L?M?S K,ISAKSSON U,et al.Constipation and laxative use among people living in nursing homes in 2007 and 2013[J].BMC Geriatrics,2019,19(1):38.DOI:10.1186/s12877-019-1054-x.
[3] CHU H,ZHONG L,LI H,et al.Epidemiology characteristics of constipation for general population,pediatric population,and elderly population in China[J].Gastroenterology Research and Practice,2014:532734.DOI:10.1155/2014/532734.
[4] HARRIS L A,CHANG C H.Burden of constipation:looking beyond bowel movements[J].The American Journal of Gastroenterology,2022,117(4S):S2-S5.DOI:10.14309/ajg.00000000000001708.
[5] ARCO S,SALDA?A E,SERRA-PRAT M,et al.Functional constipation in older adults:prevalence,clinical symptoms and subtypes,association with frailty,and impact on quality of life[J].Gerontology,2022,68(4):397-406.DOI:10.1159/000517212.
[6] OH S J,FULLER G,PATEL D,et al.Chronic constipation in the United States:results from a population-based survey assessing healthcare seeking and use of pharmacotherapy[J].The American Journal of Gastroenterology,2020,115(6):895-905.DOI:10.14309/ajg.00000000000000614.
[7] HARRIS L A,HORN J,KISSOUS-HUNT M,et al.The better understanding and recognition of the disconnects,experiences,and needs of patients with chronic idiopathic constipation (BURDEN-CIC) study:results of an online questionnaire[J].Advances in Therapy,2017,34(12):2661-2673.DOI:10.1007/s12325-017-0633-5.
[8] ALSALIMY N,MADI L,AWAISU A.Efficacy and safety of laxatives for chronic constipation in long-term care settings:a systematic review[J].Journal of Clinical Pharmacy and Therapeutics,2018,43(5):595-605.DOI:10.1111/jcpt.12721.
[9] DENNISON C,PRASAD M,LLOYD A,et al.The health-related quality of life and economic burden of constipation[J].Pharmacoeconomics,2005,23(5):461-476.DOI:10.2165/00019053-200523050-00006.
[10] DE GIORGIO R,RUGGERI E,STANGHELLINI V,et al.Chronic constipation in the elderly:a primer for the gastroenterologist[J].BMC Gastroenterology,2015,15:130.DOI:10.1186/s12876-015-0366-3.
[11] WASTESSON J W,MORIN L,TAN E C K,et al.An update on the clinical consequences of polypharmacy in older adults:a narrative review[J].Expert Opinion on Drug Safety,2018,17(12):1185-1196.DOI:10.1080/14740338.2018.1546841.
[12] BROWNLEE S,CHALKIDOU K,DOUST J,et al.Evidence for overuse of medical services around the world[J].The Lancet,2017,390(10090):156-168.DOI:10.1016/S0140-6736(16)32585-5.
[13] SCOTT I A,DUCKETT S J.In search of professional consensus in defining and reducing low-value care[J].The Medical Journal of Australia,2015,203(4):179-181.DOI:10.5694/mja14.01664.
[14] BAHLMAN-VAN OOIJEN W,GIESEN J,BAKKER-JACOBS A,et al.Low-value and high-value care recommendations in nursing:a systematic assessment of clinical practice guidelines[J].Journal of Nursing Scholarship,2024,57(3):486-499.DOI:10.1111/jnu.13029.
[15] GARNER S,LITTLEJOHNS P.Disinvestment from low value clinical interventions:NICEly done?[J].British Medical Journal,2011,343(1):d4519.DOI:10.1136/bmj.d4519.
[16] ALVARO D,CARACENI A T,COLUZZI F,et al.What to do and what not to do in the management of opioid-induced constipation:a choosing wisely report[J].Pain and Therapy,2020,9(2):657-667.DOI:10.1007/s40122-020-00195-z.
[17] DICENSO A,BAYLEY L,HAYNES R B.Accessing pre-appraised evidence:fine-tuning the 5S model into a 6S model[J].Evidence-Based Nursing,2009,12(4):99-101.DOI:10.1136/ebn.12.4.99-b.
[18] GLIWA C,PEARSON S D.Evidentiary rationales for the Choosing Wisely Top 5 lists[J].Journal of the American Medical Association,2014,311(14):1443-1444.DOI:10.1001/jama.2013.285362.
[19] American Academy of Nursing announced engagement in National Choosing Wisely Campaign[J].Nursing Outlook,2015,63(1):96-98.DOI:10.1016/j.outlook.2014.12.017.
[20] SU W,SONG S,DONG H,et al.Identifying and comparing low-value care recommendations for coronary heart disease prevention,diagnosis,and treatment in the US and China[J].International Journal of Cardiology,2023,374:1-5.DOI:10.1016/j.ijcard.2022.12.031.
[21] 关瑜山,伍思涵,李杰红,等.基于我国临床护理实践指南的护理低价值项目清单构建[J].护理学杂志,2023,38(4):66-71.DOI:10.3870/j.issn.1001-4152.2023.04.066.
[22] 梁瑞,雷婷婷,陈景侠,等.基于指南的低价值临床护理行为的系统分析[J].当代护士(中旬刊),2021,28(12):11-17.DOI:10.19793/j.cnki.1006-6411.2021.35.004.
[23] 中华医学会,中华医学会杂志社,中华医学会消化病学分会,等.慢性便秘基层诊疗指南(2019年)[J].中华全科医师杂志,2020,19(12):1100-1107.DOI:10.3760/cma.j.cn114798-20201030-01109.
[24] 李佳霁,邢晅毓,李野,等.经穴推拿缓解患者便秘效果的Meta分析[J].护理管理杂志,2024,24(11):986-990.DOI:10.3969/j.issn.1671-315x.2024.11.013.
[25] LEIGH J P,SYPES E E,STRAUS S E,et al.Determinants of the de-implementation of low-value care:a multi-method study[J].BMC Health Services Research,2022,22(1):450.DOI:10.1186/s12913-022-07827-4.
[26] UPVALL M J,BOURGAULT A M.De-implementation:a concept analysis[J].Nursing Forum,2018,53:376-382.DOI:10.1111/nuf.12256.
[27] LAAN B J,MAASKANT J M,SPIJKERMAN I J B,et al.De-implementation strategy to reduce inappropriate use of intravenous and urinary catheters (RICAT):a multicentre,prospective,interrupted time-series and before and after study[J].The Lancet Infectious Diseases,2020,20(7):864-872.DOI:10.1016/S1473-3099(19)30709-1.
[28] WANG T,SABEL M S,DOSSETT L A.A framework for de-implementation in surgery[J].Annals of Surgery,2021,273(3):e105-e107.DOI:10.1097/SLA.0000000000004325.
[29] MCKAY V R,TETTEH E K,REID M J,et al.Better service by doing less:introducing de-implementation research in HIV[J].Current HIV/AIDS Reports,2020,17(5):431-437.DOI:10.1007/s11904-020-00517-y.
[30] ALDERSON S L,FARRAGHER T M,WILLIS T A,et al.The effects of an evidence- and theory-informed feedback intervention on opioid prescribing for non-cancer pain in primary care:a controlled interrupted time series analysis[J].PLoS Medicine,2021,18(10):e1003796.DOI:10.1371/journal.pmed.1003796.
基本信息:
DOI:
中图分类号:R473.5
引用信息:
[1]李晶晶,韩柳,范雪燕等.老年人便秘非处方药物应用清单的构建及初步应用[J].护理管理杂志,2025,25(08):645-649.
基金信息:
2023年北京中医药大学研究生自主科研课题(ZJKT2023071)