Department of Hospital, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA.
J Patient Saf. 2013 Sep;9(3):150-3. doi: 10.1097/PTS.0b013e318286f87d.
Hospitalized elderly patients are at risk for medication errors and nonadherence when discharged home.
To describe how older patients' medications change during and after hospitalizations and what patients ultimately take after discharge.
We conducted an observational cohort study of 95 patients aged 65 years and older admitted to Johns Hopkins Bayview Medical Center in 2007. Inclusion criteria included admissions longer than 24 hours and discharge to home. Medication lists from three periods were recorded: prehospitalization, day of discharge, and 3 days after discharge. In comparing lists, we characterized: new and discontinued medications, changes in dosage, and changes in frequency.
Before admission, patients were taking a total of 701 medications (mean, 7 per patient). Upon discharge, 192 new medicines were started (2.0 per patient), 76 discontinued (0.8 per patient), 67 changed in frequency, (0.7 per patient), and 45 changed in dosage (0.5 per patient). Antibiotics and antihypertensives were the most commonly prescribed new medications. Antihypertensives were also most likely to be discontinued. At day 3 after discharge, patients were adherent with 98% (763/778) of medications. However, 25% of antihypertensives and 88% analgesics discontinued by hospitalists on the day of discharge were reinitiated by patients upon their return home.
During hospitalizations, medications of older adults change substantially. Despite clear medication reconciliation efforts in the hospital environment, medication errors occur upon discharge to home. Because current standards are yielding suboptimal results, alternate methodologies for promoting medication adherence should also be considered, developed, and studied for effectiveness.
住院的老年患者在出院回家时存在用药错误和不依从的风险。
描述老年患者在住院期间和出院后其药物治疗如何变化，以及他们最终在出院后服用哪些药物。
我们对 2007 年约翰霍普金斯湾景医疗中心收治的 95 名年龄在 65 岁及以上的患者进行了一项观察性队列研究。纳入标准包括住院时间超过 24 小时和出院回家。记录了三个时期的药物清单：住院前、出院当天和出院后 3 天。在比较清单时，我们描述了：新用和停用的药物、剂量变化和使用频率变化。
入院前，患者共服用 701 种药物（平均每人 7 种）。出院时，开始使用 192 种新药（每人 2.0 种），停用 76 种（每人 0.8 种），改变使用频率 67 次（每人 0.7 次），改变剂量 45 次（每人 0.5 次）。抗生素和降压药是最常开的新药。降压药也最有可能被停用。出院后第 3 天，患者对 778 种药物中的 98%（763/778）具有依从性。然而，在出院当天，由医院医生停用的 25%的降压药和 88%的镇痛药，在患者返回家中后又重新开始使用。
在住院期间，老年患者的药物治疗发生了很大的变化。尽管在医院环境中进行了明确的药物重整工作，但在出院回家时仍会发生用药错误。由于目前的标准效果不理想，也应该考虑、制定和研究其他促进药物依从性的方法。
