手术当日患者药物依从性的预测因素以及为患者提供标准化且简化的用药说明的效果。

Predictors of patient medication compliance on the day of surgery and the effects of providing patients with standardized yet simplified medication instructions.

作者信息

Vetter Thomas R, Downing Michelle E, Vanlandingham Sean C, Noles Kristen M, Boudreaux Arthur M

机构信息

From the Department of Anesthesiology (T.R.V., M.E.D., A.M.B.), Department of Emergency Medicine (S.C.V.), School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; and Department of Nursing and the Center for Nursing Excellence (K.M.N.), University of Alabama at Birmingham Hospital, Birmingham, Alabama.

出版信息

Anesthesiology. 2014 Jul;121(1):29-35. doi: 10.1097/ALN.0000000000000175.

DOI:10.1097/ALN.0000000000000175

PMID:24518232

Abstract

BACKGROUND

Anesthesiologists are responsible for optimizing patients' preoperative medications, including maximizing their compliance with preoperative medication instructions. The authors hypothesized that a standardized, simplified instruction sheet presented and verbally reinforced during the preanesthesia clinic visit would improve patient medication compliance on the day of surgery.

METHODS

An unmatched case-control design was applied, with nonrandomized, preintervention (controls) and postintervention (cases) data collected. In the preintervention group, patient education/instruction regarding taking medications on the day of surgery continued in the existing, unstandardized manner. In the postintervention group, patients were given a simplified, multicolored Preoperative Patient Medication Instruction Sheet, which was consistently verbally reviewed with patients. Group differences and independent variable associations were analyzed with conventional inferential biostatistics.

RESULTS

A total of 521 and 531 patients were enrolled in the preintervention group and postintervention group, respectively. Of this, 309 patients (60%) of preintervention group versus 391 patients (74%) of postintervention group (P < 0.001) were compliant with their preoperative medication instructions on the day of surgery. Use of the Preoperative Medication Instruction Sheet (adjusted odds ratio [aOR] = 1.83; P < 0.001), Caucasian race (aOR = 1.74; P = 0.007), and recalling receiving both verbal/written preoperative medication instructions (aOR = 1.51; P = 0.006) were associated with greater patient medication compliance. Older age (aOR = 0.67; P = 0.014) and higher American Society of Anesthesiologists status (aOR = 0.60; P = 0.004) were associated with lesser patient medication compliance.

CONCLUSIONS

A standardized, multicolored, pictorial Preoperative Patient Medication Instruction Sheet, with patient communication in both verbal/written forms, seems to improve patient medication compliance on the day of surgery. African-Americans, older patients, and those with greater comorbidities may require a more concerted effort to achieve an adequate preoperative medication compliance.

摘要

背景

麻醉医生负责优化患者的术前用药，包括使患者最大程度地遵守术前用药说明。作者推测，在麻醉前门诊就诊时提供并通过口头强化的标准化、简化说明书，会提高患者在手术当天的用药依从性。

方法

采用非匹配病例对照设计，收集非随机的干预前（对照组）和干预后（病例组）数据。在干预前组，关于手术当天用药的患者教育/指导仍以现有的非标准化方式进行。在干预后组，患者会收到一份简化的、彩色的《术前患者用药说明书》，并始终与患者进行口头回顾。使用传统的推断性生物统计学方法分析组间差异和自变量关联。

结果

干预前组和干预后组分别纳入了521例和531例患者。其中，干预前组309例患者（60%）与干预后组391例患者（74%）在手术当天遵守了术前用药说明（P<0.001）。使用《术前用药说明书》（调整优势比[aOR]=1.83；P<0.001）、白种人（aOR=1.74；P=0.007）以及回忆收到了术前用药的口头/书面说明（aOR=1.51；P=0.006）与更高的患者用药依从性相关。年龄较大（aOR=0.67；P=0.014）和美国麻醉医师协会分级较高（aOR=0.60；P=0.004）与较低的患者用药依从性相关。