دورية أكاديمية
أعرض في EDS

Determinants of appropriate antibiotic and NSAID prescribing in unscheduled outpatient settings in the veterans health administration.

التفاصيل البيبلوغرافية
العنوان: Determinants of appropriate antibiotic and NSAID prescribing in unscheduled outpatient settings in the veterans health administration.
المؤلفون: Ward MJ; Education, and Clinical Center (GRECC), VA , Geriatric Research, Tennessee Valley Healthcare System, 2525 West End Avenue, Ste. 1430, Nashville, TN, 37203, USA. michael.ward1@va.gov.; Medicine Service, Tennessee Valley Healthcare System, Nashville, TN, USA. michael.ward1@va.gov.; Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. michael.ward1@va.gov.; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA. michael.ward1@va.gov., Matheny ME; Education, and Clinical Center (GRECC), VA , Geriatric Research, Tennessee Valley Healthcare System, 2525 West End Avenue, Ste. 1430, Nashville, TN, 37203, USA.; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA.; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA.; Division of General Internal Medicine & Public Health, Vanderbilt University Medical Center, Nashville, TN, USA., Rubenstein MD; Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA., Bonnet K; Department of Psychology, Vanderbilt University, Nashville, TN, USA., Dagostino C; Department of Psychology, Vanderbilt University, Nashville, TN, USA., Schlundt DG; Department of Psychology, Vanderbilt University, Nashville, TN, USA., Anders S; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA.; Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center, Nashville, TN, USA., Reese T; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA., Mixon AS; Education, and Clinical Center (GRECC), VA , Geriatric Research, Tennessee Valley Healthcare System, 2525 West End Avenue, Ste. 1430, Nashville, TN, 37203, USA.; Section of Hospital Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
المصدر: BMC health services research [BMC Health Serv Res] 2024 May 18; Vol. 24 (1), pp. 640. Date of Electronic Publication: 2024 May 18.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: BioMed Central Country of Publication: England NLM ID: 101088677 Publication Model: Electronic Cited Medium: Internet ISSN: 1472-6963 (Electronic) Linking ISSN: 14726963 NLM ISO Abbreviation: BMC Health Serv Res Subsets: MEDLINE
أسماء مطبوعة: Original Publication: London : BioMed Central, [2001-
مواضيع طبية MeSH: Anti-Inflammatory Agents, Non-Steroidal*/therapeutic use , United States Department of Veterans Affairs* , Anti-Bacterial Agents*/therapeutic use , Inappropriate Prescribing*/statistics & numerical data , Inappropriate Prescribing*/prevention & control , Qualitative Research* , Practice Patterns, Physicians'*/statistics & numerical data, Humans ; United States ; Male ; Female ; Interviews as Topic ; Middle Aged ; Outpatients ; Tennessee
مستخلص: Background: Despite efforts to enhance the quality of medication prescribing in outpatient settings, potentially inappropriate prescribing remains common, particularly in unscheduled settings where patients can present with infectious and pain-related complaints. Two of the most commonly prescribed medication classes in outpatient settings with frequent rates of potentially inappropriate prescribing include antibiotics and nonsteroidal anti-inflammatory drugs (NSAIDs). In the setting of persistent inappropriate prescribing, we sought to understand a diverse set of perspectives on the determinants of inappropriate prescribing of antibiotics and NSAIDs in the Veterans Health Administration.
Methods: We conducted a qualitative study guided by the Consolidated Framework for Implementation Research and Theory of Planned Behavior. Semi-structured interviews were conducted with clinicians, stakeholders, and Veterans from March 1, 2021 through December 31, 2021 within the Veteran Affairs Health System in unscheduled outpatient settings at the Tennessee Valley Healthcare System. Stakeholders included clinical operations leadership and methodological experts. Audio-recorded interviews were transcribed and de-identified. Data coding and analysis were conducted by experienced qualitative methodologists adhering to the Consolidated Criteria for Reporting Qualitative Studies guidelines. Analysis was conducted using an iterative inductive/deductive process.
Results: We conducted semi-structured interviews with 66 participants: clinicians (N = 25), stakeholders (N = 24), and Veterans (N = 17). We identified six themes contributing to potentially inappropriate prescribing of antibiotics and NSAIDs: 1) Perceived versus actual Veterans expectations about prescribing; 2) the influence of a time-pressured clinical environment on prescribing stewardship; 3) Limited clinician knowledge, awareness, and willingness to use evidence-based care; 4) Prescriber uncertainties about the Veteran condition at the time of the clinical encounter; 5) Limited communication; and 6) Technology barriers of the electronic health record and patient portal.
Conclusions: The diverse perspectives on prescribing underscore the need for interventions that recognize the detrimental impact of high workload on prescribing stewardship and the need to design interventions with the end-user in mind. This study revealed actionable themes that could be addressed to improve guideline concordant prescribing to enhance the quality of prescribing and to reduce patient harm.
(© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)
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فهرسة مساهمة: Keywords: Antibiotics; Emergency Department; Non-Steroidal Anti-Inflammatory Drugs; Prescribing Stewardship; Primary Care; Qualitative Methods; Urgent Care
تواريخ الأحداث: Date Created: 20240517 Date Completed: 20240517 Latest Revision: 20240521
رمز التحديث: 20240521
مُعرف محوري في PubMed: PMC11102113
DOI: 10.1186/s12913-024-11082-0
PMID: 38760660
قاعدة البيانات: MEDLINE
الوصف
تدمد:1472-6963
DOI:10.1186/s12913-024-11082-0