Enfermeros prescribiendo medicamentos en centros geriátricos: mapeo Internacional

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Abstract

Resumen Objetivo: La meta de este estudio fue identificar la percepción de los enfermeros y médicos con respecto a los centros de atención de largo plazo, al mismo tiempo, explicar la intervención de los enfermeros en la prescripción médica. Metodología: estudio multinacional transversal en el que participaron enfermeros y médicos en centros de cuidado geriátrico durante las fechas de abril y octubre de 2017. Se utilizaron tres cuestionarios en línea en idiomas francés e inglés. Resultados: un 78.7% de médicos discutieron la relevancia que existe entre las prescripciones y enfermeros competentes. El mapeo demuestra la relación entre el nivel de evidencia que existe en el rol de enfermería y las prescripciones médicas, y enfermeros autorizados en los 51 países participantes. Conclusiones: La relacion interpersonal entre médicos y enfermeros es esencial para facilitar el rol de enfermería en el manejo de tratamientos eficientes.

Translated abstract

Abstract Objective: the aim of this study was to identify the perceptions of nurses and physicians and describe the involvement of nurses in medical prescription in general and that of antibiotics in particular, in geriatric institutions. Methods: a cross-sectional multinational study was conducted among nurses and physicians in geriatric institutions between April and October 2017. Data was collected using three online questionnaires in both French and English. Results: in total, 78.7% of doctors discussed the relevance of the prescription with competent nurses. A map shows the relationship between the evidence level of nursing role in medical prescription, and prescriptive authorization nurses in the 51 participating countries. Conclusions: interpersonal physician-nurse relationships are essential in facilitating the nursing role of effective treatment management.

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Prevalence of multimorbidity in the adult population attending primary care in Portugal: a cross-sectional study

Filipe Prazeres, Luiz Santiago (2015)

Objectives To determine the prevalence of multimorbidity in the adult population attending primary care in Portugal, to identify associated sociodemographic factors, and to reveal combinations of chronic health problems. Design Cross-sectional, analytical study. Setting Primary Care Centres in mainland Portugal across the five Portuguese Healthcare Administrative Regions. Participants 1279 women and 714 men agreed to participate. The mean age was 56.3 years (59.0 years for men; 54.8 years for women). The most frequent marital status was married/cohabiting (69.5%). The most predominant living arrangement was living as a couple (57.2%). A considerable proportion consisted of pensioners/retirees (41.5%) and adults with a low educational level (48.7%). Sufficient monthly income was reported in 54.4% of the cases. Primary outcome measures For each patient, multimorbidity was measured either by the presence of ≥2 or ≥3 chronic health problems, from a list of 147 chronic health problems. Clinical data were collected using the general practitioner's knowledge of the patient's history, patient's self-report and medical records. Cluster analyses were performed to reveal distinct patterns of multimorbidity. Secondary outcome measures Patient social and demographic data (sex, age, residence area, current marital status, number of years of formal education, living arrangements, professional status and self-perceived economic status). Logistic regression analyses were performed to determine the association between sociodemographic factors and multimorbidity. Results Multimorbidity (2 or more chronic health problems) was present in 72.7%. When a cut-off of three or more was used, an expressive percentage of multimorbidity (57.2%) remained present. The likelihood of having multimorbidity increased significantly with age. Pensioners/retirees and adults with low levels of education were significantly more likely to suffer from multimorbidity. Cardiometabolic and mental disorders were the most common chronic health problems. Six multimorbidity clusters have been identified. Conclusions Multimorbidity was found to be a common occurrence in the Portuguese primary care users. Future primary healthcare policies should take multimorbidity into consideration.

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Interventions to optimise prescribing in care homes: systematic review.

Azeem Majeed, S. Singh, Alex Bottle … (2011)

prescribing for older people is a complex process and can elevate the risk of inappropriate prescribing, with potentially severe consequences. With a growing ageing population, strategies to improve prescribing in care homes are essential. Our aim was to review systematically the effects of interventions to optimise prescribing in care homes. databases searched were MEDLINE, EMBASE, International Pharmaceutical Abstracts and the Cochrane Library from 1990. Search terms included were 'nursing home', 'residential home', 'inappropriate prescribing', 'education' and 'intervention'. Two independent reviewers undertook screening and methodological quality assessment, using the Downs and Black rating scale. the search strategy retrieved 16 studies that met the inclusion criteria. Four intervention strategies were identified: staff education, multi-disciplinary team (MDT) meetings, pharmacist medication reviews and computerised clinical decision support systems (CDSSs). Complex educational programmes that focused on improving patients' behavioural management and drug prescribing were the most studied area, with six of eight studies highlighting an improvement in prescribing. Mixed results were found for pharmacist interventions. CDSSs were evaluated in two studies, with one showing a significant improvement in appropriate drug orders. Two of three studies examining MDT meetings found an overall improvement in appropriate prescribing. A meta-analysis could not be performed due to heterogeneity in the outcome measures. results are mixed and there is no one interventional strategy that has proved to be effective. Nevertheless, education including academic detailing seems to show most promise. A multi-faceted approach and clearer policy guidelines are likely to be required to improve prescribing for these vulnerable patients.

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Factors influencing antibiotic prescribing in long-term care facilities: a qualitative in-depth study

Laura W van Buul, Jenny van der Steen, Sarah Doncker … (2014)

Background Insight into factors that influence antibiotic prescribing is crucial when developing interventions aimed at a more rational use of antibiotics. We examined factors that influence antibiotic prescribing in long-term care facilities, and present a conceptual model that integrates these factors. Methods Semi-structured qualitative interviews were conducted with physicians (n = 13) and nursing staff (n = 13) in five nursing homes and two residential care homes in the central-west region of the Netherlands. An iterative analysis was applied to interviews with physicians to identify and categorize factors that influence antibiotic prescribing, and to integrate these into a conceptual model. This conceptual model was triangulated with the perspectives of nursing staff. Results The analysis resulted in the identification of six categories of factors that can influence the antibiotic prescribing decision: the clinical situation, advance care plans, utilization of diagnostic resources, physicians’ perceived risks, influence of others, and influence of the environment. Each category comprises several factors that may influence the decision to prescribe or not prescribe antibiotics directly (e.g. pressure of patients’ family leading to antibiotic prescribing) or indirectly via influence on other factors (e.g. unfamiliarity with patients resulting in a higher physician perceived risk of non-treatment, in turn resulting in a higher tendency to prescribe antibiotics). Conclusions Our interview study shows that several non-rational factors may affect antibiotic prescribing decision making in long-term care facilities, suggesting opportunities to reduce inappropriate antibiotic use. We developed a conceptual model that integrates the identified categories of influencing factors and shows the relationships between those categories. This model may be used as a practical tool in long-term care facilities to identify local factors potentially leading to inappropriate prescribing, and to subsequently intervene at the level of those factors to promote appropriate antibiotic prescribing. Electronic supplementary material The online version of this article (doi:10.1186/1471-2318-14-136) contains supplementary material, which is available to authorized users.

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Journal

Journal ID (publisher-id): index

Title: Index de Enfermería

Abbreviated Title: Index Enferm

Publisher: Fundación Index (Granada, Granada, Spain )

ISSN (Print): 1132-1296

ISSN (Electronic): 1699-5988

Publication date (Print and electronic): September 2019

Volume: 28

Issue: 3

Pages: 120-124

Affiliations

[4] orgnameMontréal University orgdiv1Faculty of Nursing Sciences Canadá

[1] orgnameUniversity Paris 13 orgdiv1Nursing Sciences Research chair orgdiv2Laboratory Educations and Health Practices France

[2] orgnameNursing Sciences Research chair France

[3] orgnameIslamic University of Lebanon orgdiv1Faculty of Nursing Sciences Lebanon

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Publisher ID: S1132-12962019000200006 Publisher ID: S1132-1296(19)02800300006

SO-VID: c44e70f1-dc1b-4687-b896-a21e5eb8adc2

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This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 International License.

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Date received : 21 January 2019

Date accepted : 30 March 2019

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Figures: 0, Tables: 0, Equations: 0, References: 19, Pages: 5

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Enfermeros prescribiendo medicamentos en centros geriátricos: mapeo Internacional Translated title: Nurses prescribing medications in geriatric centers: international mapping

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Most cited references 16

Prevalence of multimorbidity in the adult population attending primary care in Portugal: a cross-sectional study

Interventions to optimise prescribing in care homes: systematic review.

Factors influencing antibiotic prescribing in long-term care facilities: a qualitative in-depth study

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