Shiu Jennifer R, Fradette Miriam, Padwal Raj S, Majumdar Sumit R, Youngson Erik, Bakal Jeffrey A, McAlister Finlay A
Pharmacy Services, Alberta Health Services, Edmonton, Alberta, Canada.
The Epidemiology Coordinating and Research (EPICORE) Centre, University of Alberta, Edmonton, Alberta, Canada.
Pharmacotherapy. 2016 Apr;36(4):415-21. doi: 10.1002/phar.1734.
To identify the frequency of unintended medication discrepancies 30 days postdischarge from medicine wards with interprofessional medication reconciliation processes and clinical import.
Prospective cohort study of adults discharged between October 2013 and November 2014 from two teaching hospitals in Edmonton, Canada. The Best Possible Medication Discharge Plan (BPMDP) was prepared for all patients. Patients were called 30 days postdischarge to determine the medication discrepancy rate from the BPMDP and whether this was intentional or unintentional; three clinicians used standardized criteria to determine if the discrepancy was inconsequential. Electronic health records and patient contact were used to ascertain death, hospital readmissions, and emergency department (ED) visits at 90 days.
Of 433 patients (mean age 64 yrs, 52% female, median discharge prescriptions 6 [interquartile range 4-9]), 168 (38.8%) had at least one unintentional medication discrepancy at 30 days (325 total discrepancies; median one [interquartile range 1-2 discrepancies per patient]). Patients with unintentional medication discrepancies were older (65.9 vs 61.9 yrs, p=0.03) with more discharge medications (7 vs 6, p=0.03). Most unintentional discrepancies (91.1%) were judged inconsequential. The presence of an unintentional medication discrepancy was not associated with 90-day readmission or death (42/167 [25.1%] vs 64/263 [24.3%], adjusted odds ratio 0.96 [95% confidence interval 0.60-1.54]) or ED visits (69 [41.3%] vs 101 [38.4%], adjusted odds ratio 1.11 [95% confidence interval 0.74-1.67].
Despite the presence of an interprofessional medication reconciliation process, over one-third of patients had a medication discrepancy within 30 days of discharge, although most were inconsequential and there was no association between unintended medication discrepancies and risk of readmission, ED visit, or death 3 months after discharge.
确定在药物治疗科室出院30天后，通过跨专业药物重整流程出现的意外用药差异的频率及其临床意义。
对2013年10月至2014年11月间从加拿大埃德蒙顿市两家教学医院出院的成年人进行前瞻性队列研究。为所有患者制定了最佳可能的出院用药计划（BPMDP）。出院30天后对患者进行电话随访，以确定与BPMDP相比的用药差异率，以及该差异是有意还是无意造成的；三名临床医生使用标准化标准来确定该差异是否无关紧要。利用电子健康记录和患者联系方式来确定90天时的死亡、再次入院以及急诊就诊情况。
433例患者（平均年龄64岁，52%为女性，出院处方中位数为6[四分位间距4 - 9]）中，168例（38.8%）在出院30天时至少有一项意外用药差异（共325项差异；患者差异中位数为1[四分位间距为每位患者1 - 2项差异]）。有意外用药差异的患者年龄更大（65.9岁对61.9岁，p = 0.03），出院用药更多（7种对6种，p = 0.03）。大多数意外差异（91.1%）被判定为无关紧要。出现意外用药差异与90天内再次入院或死亡无关（42/167[25.1%]对64/263[24.3%]，调整后的优势比为0.96[95%置信区间0.60 - 1.54]），与急诊就诊也无关（69例[41.3%]对101例[38.4%]，调整后的优势比为1.11[95%置信区间0.74 - 1.67]）。
尽管存在跨专业药物重整流程，但超过三分之一的患者在出院30天内出现用药差异，不过大多数差异无关紧要，且意外用药差异与出院3个月后再次入院、急诊就诊或死亡风险之间无关联。
