Objectives

1) To understand and investigate the experiences of accredited clinical pharmacists (ACP) using computerised clinical decision support systems (CCDSS) during medication reviews for older people, including those living with dementia; 2) To design, develop, validate, and evaluate a CCDSS that incorporates pharmacological and other deprescribing tools to aid person-centred management of high-risk medications in older adults living with and without dementia.

Methods

This study consisted of three phases and was designed on scenario-based methodology: a) the development phase, which included an exploratory survey and prototype building; b) the validation phase, which included qualitative data collection and usability testing with ACPs, general practitioners (GPs) and carers for people living with dementia; and c) the evaluation phase, using mixed-methods analyses.

Results

The exploratory survey found that ACPs required a flexible, and reliable CCDSS to support them with clinical decisions regarding high-risk medication use in older adults. The Goal-directed Medication review Electronic Decision Support System (G-MEDSS)© was developed and validated using quantitative and qualitative feedback received from ACPs, GPs and carers for people with dementia. The mean (SD) System Usability Scale score was 69.0 (12.9), which indicated fair-good usability.

Discussion and conclusions

Involving end-users in the design process refined and improved the design of G-MEDSS, allowing for a person-centred and goal-directed delivery of pharmaceutical care. G-MEDSS allows healthcare practitioners conducting medication reviews for older adults living with and without dementia to tailor pharmaceutical care to meet their goals and preferences. Future studies may explore integration of G-MEDSS with prescribing or dispensing software.

中文翻译：

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目标导向药物审查电子决策支持系统 (G-MEDSS)© 的开发、验证和评估

目标

1) 了解和调查认可临床药剂师 (ACP) 在对老年人（包括痴呆症患者）进行药物审查期间使用计算机化临床决策支持系统 (CCDSS) 的经验；2) 设计、开发、验证和评估包含药理学和其他处方工具的 CCDSS，以帮助患有和未患有痴呆症的老年人以人为本的高风险药物管理。

方法

本研究由三个阶段组成，采用基于情景的方法设计： a) 开发阶段，包括探索性调查和原型构建；b) 验证阶段，包括与 ACP、全科医生 (GP) 和痴呆症患者护理人员进行的定性数据收集和可用性测试；c) 评估阶段，使用混合方法分析。

结果

探索性调查发现，ACP 需要灵活、可靠的 CCDSS 来支持他们做出关于老年人高风险药物使用的临床决策。目标导向的药物审查电子决策支持系统 (G-MEDSS)© 是使用从 ACP、全科医生和痴呆症患者护理人员收到的定量和定性反馈开发和验证的。平均 (SD) 系统可用性量表得分为 69.0 (12.9)，这表明可用性相当好。

讨论和结论

让最终用户参与设计过程改进和改进了 G-MEDSS 的设计，从而实现以人为本和目标导向的药物护理服务。G-MEDSS 允许医疗保健从业人员对患有和未患有痴呆症的老年人进行药物审查，以定制药物护理以满足他们的目标和偏好。未来的研究可能会探索 G-MEDSS 与处方或配药软件的集成。