药师在识别老年照护中药物相关口腔健康风险中的作用：一项关于药师和牙医视角的定性研究。

文献信息

中文摘要

引言： 药物相关口腔健康并发症，包括唾液腺功能减退、口干症、龋齿、念珠菌病、黏膜损伤和吞咽困难，在老年照护及更广泛临床实践环境中暴露于多重用药的老年人中很常见。药师越来越多地参与住院老年照护中的药物管理，可能处于有利位置，能够支持更早识别药物相关口腔健康风险。尽管如此，既往文献提示，口腔健康往往未充分整合到药物管理、跨学科照护路径和药师教育框架中。
目的： 本研究旨在探讨药师和牙医对药师在老年照护实践中识别药物相关口腔健康风险作用的看法，包括药师的教育需求、跨学科照护考虑因素，以及实用口腔健康资源的优选实施策略。
方法： 在澳大利亚开展了一项定性描述性研究，采用半结构化访谈，访谈对象为具有照护老年人、管理多重用药或从事老年照护相关实践经验。参与者采用目的性抽样招募，以涵盖药学和牙科环境中一系列临床视角。访谈进行录音，逐字转录，并使用反思性主题分析法进行分析。
结果： 从十三名参与者（六名牙医和七名药师）中确定了三个主要主题：对药物相关口腔健康风险的正式准备有限；在碎片化照护系统中对口腔并发症的反应性识别；以及对实用、整合工作流程的资源的需求，以支持药师参与口腔健康照护。参与者描述了口腔健康教育有限、口腔并发症识别延迟、转诊路径不清晰以及跨学科沟通不佳。口干症是最常被识别的症状，尽管参与者对客观唾液腺功能减退及其后果（包括龋齿、念珠菌病、吞咽困难和营养状况下降）的识别一致性较低。简洁的教育资源、决策支持工具和电子提示被强烈偏好，以支持在药物管理工作流程中更早识别和转诊。
结论： 药师和牙医描述了影响药师参与识别和管理老年照护实践中药物相关口腔健康风险的教育、跨学科和系统层面挑战。研究结果提示，实用教育资源、更清晰的转诊路径和更强的跨学科合作可能支持药师参与识别多重用药老年人的药物相关口腔健康风险。

英文摘要

INTRODUCTION: Medication-related oral health complications, including salivary gland hypofunction, xerostomia, dental caries, candidiasis, mucosal injury, and swallowing difficulties, are common among older adults exposed to polypharmacy across aged-care and broader clinical practice contexts. Pharmacists are increasingly involved in medication management in residential aged care and may be well positioned to support the earlier recognition of medication-related oral health risks. Despite this, previous literature suggests that oral health is often insufficiently integrated into medication management, interdisciplinary care pathways, and pharmacist education frameworks.
AIM: This study aimed to explore pharmacists' and dentists' perspectives on pharmacists' role in recognising medication-related oral health risks in aged-care practice, including pharmacists' educational needs, interdisciplinary care considerations, and preferred implementation strategies for practical oral health resources.
METHOD: A qualitative descriptive study was conducted in Australia using semi-structured interviews with pharmacists and dentists who had experience caring for older adults, managing polypharmacy, or working in aged-care-related practice. Participants were recruited using purposive sampling to capture a range of clinical perspectives across pharmacy and dental settings. Interviews were audio-recorded, transcribed verbatim, and analysed using reflexive thematic analysis.
RESULTS: Three major themes were identified from thirteen participants (six dentists and seven pharmacists): limited formal preparation for medication-related oral health risks; reactive recognition of oral complications within fragmented care systems; and the need for practical, workflow-integrated resources to support pharmacists' involvement in oral health care. Participants described limited oral health education, delayed recognition of oral complications, unclear referral pathways, and poor interdisciplinary communication. Xerostomia was the most commonly recognised symptom, although participants demonstrated less consistent recognition of objective salivary gland hypofunction and its consequences, including dental caries, candidiasis, swallowing difficulties, and nutritional decline. Concise educational resources, decision-support tools, and electronic prompts were strongly preferred to support earlier recognition and referral within medication management workflows.
CONCLUSION: Pharmacists and dentists described educational, interdisciplinary, and systems-level challenges affecting pharmacists' involvement in recognising and managing medication-related oral health risks in aged-care practice. Findings suggest that practical educational resources, clearer referral pathways, and stronger interdisciplinary collaboration may support pharmacists' involvement in recognising medication-related oral health risks among older adults with polypharmacy.