Louis-Simonet Martine, Kossovsky Michel P, Sarasin François P, Chopard Pierre, Gabriel Victor, Perneger Thomas V, Gaspoz Jean-Michel
Department of Internal Medicine, Geneva University Hospitals, Switzerland.
Am J Med. 2004 Oct 15;117(8):563-8. doi: 10.1016/j.amjmed.2004.03.036.
Many recently hospitalized patients lack knowledge about important aspects of their medications. We evaluated whether a structured discharge interview could improve medication knowledge.
Patients discharged with at least one discharge medication were recruited from two general internal medicine services (one experimental and one control) of a teaching hospital. During a 3-month baseline period, usual care at discharge was provided in both services. During the ensuing 3-month period, observation was continued in the control service; residents in the experimental service implemented the intervention, which consisted of a structured patient-centered discharge interview during which a computer-generated individualized treatment card was discussed with and provided to patients. One week after discharge, patients' knowledge about their medications was assessed by telephone.
We enrolled a total of 809 patients. After adjustment for patients' characteristics and for the effect of time, the intervention significantly increased the percentage of medications for which patients correctly knew the purposes (adjusted difference = 6%; 95% confidence interval [CI]: 3% to 8%; P <0.001), possible side effects (adjusted difference = 19%; 95% CI: 9% to 29%; P <0.001), and precautions to observe (adjusted difference = 9%; 95% CI: 2% to 19%; P <0.001). However, the number of medications that patients discontinued after discharge was not modified. Patients with a better knowledge of side effects of their active treatment were less likely to discontinue their medications, but there were no associations with other types of knowledge.
A structured patient-centered discharge interview, performed by residents using a standardized treatment card, significantly increased patients' knowledge about their medications. Its effects on compliance require further study.
许多近期住院的患者对其所用药物的重要方面缺乏了解。我们评估了结构化出院访谈是否能提高用药知识水平。
从一家教学医院的两个普通内科科室（一个为实验组，一个为对照组）招募至少带一种出院用药的出院患者。在为期3个月的基线期内，两个科室均提供常规出院护理。在随后的3个月期间，对照组继续进行观察；实验组的住院医师实施干预措施，即进行以患者为中心的结构化出院访谈，并在访谈过程中与患者讨论并提供一份计算机生成的个性化治疗卡片。出院一周后，通过电话评估患者对其所用药物的了解情况。
我们共纳入809例患者。在对患者特征和时间效应进行调整后，干预措施显著提高了患者正确知晓用药目的的药物百分比（调整后差异=6%；95%置信区间[CI]：3%至8%；P<0.001）、可能的副作用（调整后差异=19%；95%CI：9%至2%；P<0.001）以及需注意的事项（调整后差异=9%；95%CI：2%至19%；P<0.001）。然而，出院后患者停用药物的数量未发生改变。对正在接受治疗的副作用了解较好的患者较少停用药物，但与其他类型的知识无关联。
住院医师使用标准化治疗卡片进行以患者为中心的结构化出院访谈，显著提高了患者对其所用药物的了解。其对依从性的影响有待进一步研究。
