Department of Veterans Affairs, Tennessee Valley Healthcare System Geriatric Research Education and Clinical Center, Nashville, Tennessee; Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University, Nashville, Tennessee; Center for Health Services Research, Vanderbilt University, Nashville, Tennessee.
Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, Tennessee.
Mayo Clin Proc. 2014 Aug;89(8):1042-51. doi: 10.1016/j.mayocp.2014.04.023. Epub 2014 Jul 3.
To examine the association of patient- and medication-related factors with postdischarge medication errors.
The Vanderbilt Inpatient Cohort Study includes adults hospitalized with acute coronary syndromes and/or acute decompensated heart failure. We measured health literacy, subjective numeracy, marital status, cognition, social support, educational attainment, income, depression, global health status, and medication adherence in patients enrolled from October 1, 2011, through August 31, 2012. We used binomial logistic regression to determine predictors of discordance between the discharge medication list and the patient-reported list during postdischarge medication review.
Among 471 patients (mean age, 59 years), the mean total number of medications reported was 12, and 79 patients (16.8%) had inadequate or marginal health literacy. A total of 242 patients (51.4%) were taking 1 or more discordant medication (ie, appeared on either the discharge list or patient-reported list but not both), 129 (27.4%) failed to report a medication on their discharge list, and 168 (35.7%) reported a medication not on their discharge list. In addition, 279 participants (59.2%) had a misunderstanding in indication, dose, or frequency in a cardiac medication. In multivariable analyses, higher subjective numeracy (odds ratio [OR], 0.81; 95% CI, 0.67-0.98) was associated with lower odds of having discordant medications. For cardiac medications, participants with higher health literacy (OR, 0.84; 95% CI, 0.74-0.95), with higher subjective numeracy (OR, 0.77; 95% CI, 0.63-0.95), and who were female (OR, 0.60; 95% CI, 0.46-0.78) had lower odds of misunderstandings in indication, dose, or frequency.
Medication errors are present in approximately half of patients after hospital discharge and are more common among patients with lower numeracy or health literacy.
探讨患者和药物相关因素与出院后药物错误的关系。
范德比尔特住院患者队列研究纳入了因急性冠状动脉综合征和/或急性失代偿性心力衰竭住院的成年人。我们在 2011 年 10 月 1 日至 2012 年 8 月 31 日期间入组的患者中测量了健康素养、主观算术能力、婚姻状况、认知、社会支持、教育程度、收入、抑郁、总体健康状况和药物依从性。我们使用二项逻辑回归来确定出院药物清单与出院后药物审查期间患者报告的清单之间不一致的预测因素。
在 471 名患者（平均年龄 59 岁）中，报告的药物总数平均为 12 种，79 名患者（16.8%）的健康素养不足或临界。共有 242 名患者（51.4%）服用 1 种或多种不一致的药物（即，出现在出院清单或患者报告清单上但两者都未出现），129 名患者（27.4%）未报告出院清单上的药物，168 名患者（35.7%）报告了出院清单上未出现的药物。此外，279 名参与者（59.2%）在心脏药物的适应证、剂量或频率方面存在误解。在多变量分析中，较高的主观算术能力（比值比 [OR]，0.81；95%置信区间，0.67-0.98）与服用不一致药物的可能性降低相关。对于心脏药物，健康素养较高（OR，0.84；95%置信区间，0.74-0.95）、主观算术能力较高（OR，0.77；95%置信区间，0.63-0.95）和女性（OR，0.60；95%置信区间，0.46-0.78）的参与者，在适应证、剂量或频率方面发生误解的可能性较低。
约有一半的患者在出院后出现药物错误，并且在算术能力或健康素养较低的患者中更为常见。
