老年人的药物治疗方案复杂性与非计划住院再入院情况
Medication Regimen Complexity and Unplanned Hospital Readmissions in Older People.
作者信息
Wimmer Barbara C, Dent Elsa, Bell J Simon, Wiese Michael D, Chapman Ian, Johnell Kristina, Visvanathan Renuka
机构信息
Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
Discipline of Medicine, University of Adelaide, Adelaide, Australia Discipline of Public Health, University of Adelaide, Adelaide, Australia.
出版信息
Ann Pharmacother. 2014 Sep;48(9):1120-1128. doi: 10.1177/1060028014537469. Epub 2014 May 27.
BACKGROUND
Medication-related problems and adverse drug events are leading causes of preventable hospitalizations. Few previous studies have investigated the possible association between medication regimen complexity and unplanned rehospitalization.
OBJECTIVE
To investigate the association between discharge medication regimen complexity and unplanned rehospitalization over a 12-month period.
METHOD
The prospective study comprised patients aged ≥70 years old consecutively admitted to a Geriatrics Evaluation and Management (GEM) unit between October 2010 and December 2011. Medication regimen complexity at discharge was calculated using the 65-item validated Medication Regimen Complexity Index (MRCI). Cox proportional-hazards regression was used to compute unadjusted and adjusted hazard ratios (HRs) with 95% CIs for factors associated with rehospitalization over a 12-month follow-up period.
RESULT
Of 163 eligible patients, 99 patients had one or more unplanned hospital readmissions. When adjusting for age, sex, activities of daily living, depression, comorbidity, cognitive status, and discharge destination, MRCI (HR = 1.01; 95% CI = 0.81-1.26), number of discharge medications (HR = 1.01; 95% CI = 0.94-1.08), and polypharmacy (≥9 medications; HR = 1.12; 95% CI = 0.69-1.80) were not associated with rehospitalization. In patients discharged to nonhome settings, there was an association between rehospitalization and the number of discharge medications (HR = 1.12; 95% CI = 1.01-1.25) and polypharmacy (HR = 2.24; 95% CI = 1.02-4.94) but not between rehospitalization and MRCI (HR = 1.32; 95% CI = 0.98-1.78).
CONCLUSION
Medication regimen complexity was not associated with unplanned hospital readmission in older people. However, in patients discharged to nonhome settings, the number of discharge medications and polypharmacy predicted rehospitalization. A patient's discharge destination is an important factor in unplanned medication-related readmissions.
背景
与药物相关的问题和药物不良事件是可预防住院的主要原因。此前很少有研究调查药物治疗方案复杂性与非计划再入院之间的可能关联。
目的
调查出院药物治疗方案复杂性与12个月内非计划再入院之间的关联。
方法
这项前瞻性研究纳入了2010年10月至2011年12月期间连续入住老年病评估与管理（GEM）病房的70岁及以上患者。出院时的药物治疗方案复杂性使用经过验证的65项药物治疗方案复杂性指数（MRCI）进行计算。采用Cox比例风险回归计算12个月随访期内与再入院相关因素的未调整和调整风险比（HR）及95%置信区间（CI）。
结果
在163名符合条件的患者中，99名患者有一次或多次非计划再次住院。在对年龄、性别、日常生活活动能力、抑郁、合并症、认知状态和出院目的地进行调整后，MRCI（HR = 1.01；95%CI = 0.81 - 1.26）、出院时用药数量（HR = 1.01；95%CI = 0.94 - 1.08）和多重用药（≥9种药物；HR = 1.12；95%CI = 0.69 - 1.80）与再入院无关。在出院至非家庭环境的患者中，再入院与出院时用药数量（HR = 1.12；95%CI = 1.01 - 1.25）和多重用药（HR = 2.24；95%CI = 1.02 - 4.94）有关，但与MRCI无关（HR = 1.32；95%CI = 0.98 - 1.78）。
结论
药物治疗方案复杂性与老年人非计划再次住院无关。然而，在出院至非家庭环境的患者中，出院时用药数量和多重用药可预测再入院情况。患者的出院目的地是与药物相关的非计划再入院的一个重要因素。
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