Abstract：
BACKGROUND: Prescribing cascades can lead to unnecessary medication use, healthcare costs, and patient harm. Pharmacists oversee prescriptions from multiple prescribers and are well positioned to identify such cascades, making pharmacists key stakeholders to address them.
OBJECTIVE: To evaluate community pharmacists\' awareness, identification, and management of prescribing cascades and to assess behavioural determinants that may be targeted in future strategies to minimise inappropriate prescribing cascades.
METHODS: An online survey was developed using the Theoretical Domains Framework (TDF) and emailed to all registered community pharmacists in Ireland (n = 3775) in November 2021. Quantitative data were analysed using descriptive and inferential statistics. Free-text sections were given to capture reasons for non-resolution of identified prescribing cascades and suggestions to aid prescribing cascade identification and management; this text underwent content analysis.
RESULTS: Of the 220 respondents, 51% were aware of the term \'prescribing cascade\' before the survey, whilst 69% had identified a potentially inappropriate prescribing cascade in practice. Over one third were either slightly confident (26.4%) or not confident at all (10%) in their ability to identify potentially inappropriate prescribing cascades in patients\' prescriptions before the survey, whilst 55.2% were concerned that patients were receiving prescribing cascades they had not identified. Most respondents wanted further information/training to help prescribing cascade identification (88.3%) and management (86.1%). Four predominant TDF domains identified were common to both i) influencing non-resolution of identified prescribing cascades and ii) in the suggestions to help identify and manage prescribing cascades: \'Environmental Context and Resources\', \'Social/Professional Role and Identity\', \'Social Influences\' and \'Memory, Attention and Decision Processes\'.
CONCLUSIONS: There is a clear need to provide additional resources to help community pharmacists identify and manage prescribing cascades. These findings will support the development of theory-informed behaviour change strategies to aid the minimisation of inappropriate prescribing cascades and decrease the risk of medication-related harm for patients.
OBJECTIVE: To evaluate community pharmacists\' awareness, identification, and management of prescribing cascades and to assess behavioural determinants that may be targeted in future strategies to minimise inappropriate prescribing cascades.
METHODS: An online survey was developed using the Theoretical Domains Framework (TDF) and emailed to all registered community pharmacists in Ireland (n = 3775) in November 2021. Quantitative data were analysed using descriptive and inferential statistics. Free-text sections were given to capture reasons for non-resolution of identified prescribing cascades and suggestions to aid prescribing cascade identification and management; this text underwent content analysis.
RESULTS: Of the 220 respondents, 51% were aware of the term \'prescribing cascade\' before the survey, whilst 69% had identified a potentially inappropriate prescribing cascade in practice. Over one third were either slightly confident (26.4%) or not confident at all (10%) in their ability to identify potentially inappropriate prescribing cascades in patients\' prescriptions before the survey, whilst 55.2% were concerned that patients were receiving prescribing cascades they had not identified. Most respondents wanted further information/training to help prescribing cascade identification (88.3%) and management (86.1%). Four predominant TDF domains identified were common to both i) influencing non-resolution of identified prescribing cascades and ii) in the suggestions to help identify and manage prescribing cascades: \'Environmental Context and Resources\', \'Social/Professional Role and Identity\', \'Social Influences\' and \'Memory, Attention and Decision Processes\'.
CONCLUSIONS: There is a clear need to provide additional resources to help community pharmacists identify and manage prescribing cascades. These findings will support the development of theory-informed behaviour change strategies to aid the minimisation of inappropriate prescribing cascades and decrease the risk of medication-related harm for patients.
摘要：
背景：处方级联可能导致不必要的药物使用，医疗费用,和病人的伤害。药剂师监督多个处方者的处方，并处于良好的位置来识别这种级联，让药剂师成为关键利益相关者来解决这些问题。
目的：评估社区药师的认识，identification,以及处方级联的管理，并评估未来策略中可能针对的行为决定因素，以最大程度地减少不适当的处方级联。
方法：使用理论域框架（TDF）进行了一项在线调查，并于2021年11月通过电子邮件发送给爱尔兰的所有注册社区药剂师（n=3775）。使用描述性和推断性统计分析定量数据。给出了自由文本部分，以捕获未解决已确定的处方级联的原因以及帮助处方级联识别和管理的建议；本文进行了内容分析。
结果：在220名受访者中，51%的人在调查前知道“处方级联”这个词，而69%的人在实践中发现了潜在的不适当的处方级联。在调查前，超过三分之一的人对他们识别患者处方中潜在不适当的处方级联的能力略有信心(26.4%)或完全不自信(10%)。而55.2%的人担心患者正在接受他们尚未确定的处方级联。大多数受访者希望进一步的信息/培训，以帮助处方级联识别（88.3％）和管理（86.1％）。确定的四个主要的TDF域在以下两个方面都很常见：i）影响已确定的处方级联的非分辨率，以及ii）在帮助确定和管理处方级联的建议中：“环境背景和资源”，“社会/职业角色和身份”，\'社会影响\'和\'记忆，注意和决策过程。
结论：显然需要提供额外的资源来帮助社区药剂师识别和管理处方级联。这些发现将支持理论知情行为改变策略的发展，以帮助最小化不适当的处方级联，并降低患者与药物相关伤害的风险。
目的：评估社区药师的认识，identification,以及处方级联的管理，并评估未来策略中可能针对的行为决定因素，以最大程度地减少不适当的处方级联。
方法：使用理论域框架（TDF）进行了一项在线调查，并于2021年11月通过电子邮件发送给爱尔兰的所有注册社区药剂师（n=3775）。使用描述性和推断性统计分析定量数据。给出了自由文本部分，以捕获未解决已确定的处方级联的原因以及帮助处方级联识别和管理的建议；本文进行了内容分析。
结果：在220名受访者中，51%的人在调查前知道“处方级联”这个词，而69%的人在实践中发现了潜在的不适当的处方级联。在调查前，超过三分之一的人对他们识别患者处方中潜在不适当的处方级联的能力略有信心(26.4%)或完全不自信(10%)。而55.2%的人担心患者正在接受他们尚未确定的处方级联。大多数受访者希望进一步的信息/培训，以帮助处方级联识别（88.3％）和管理（86.1％）。确定的四个主要的TDF域在以下两个方面都很常见：i）影响已确定的处方级联的非分辨率，以及ii）在帮助确定和管理处方级联的建议中：“环境背景和资源”，“社会/职业角色和身份”，\'社会影响\'和\'记忆，注意和决策过程。
结论：显然需要提供额外的资源来帮助社区药剂师识别和管理处方级联。这些发现将支持理论知情行为改变策略的发展，以帮助最小化不适当的处方级联，并降低患者与药物相关伤害的风险。
