Perry Tracy D, Nye Ann Marie, Johnson Steven W
J Am Pharm Assoc (2003). 2017 Jul-Aug;57(4):488-492. doi: 10.1016/j.japh.2017.03.010. Epub 2017 May 8.
To compare the rate of discrepancies per patient for medications changed during hospitalization in patients with and without prescription provider comments at hospital discharge. Secondary objectives included comparing 35-day readmission rates, describing the overall medication discrepancy rate stratified by age group and type of discrepancy, collecting average number of medication changes, and reporting percentage change in admission medications at discharge.
This single-center prospective cohort included NC Medicaid recipients discharged from East Carolina University Family Medicine service from November 1, 2015, to January 31, 2016. Patients were assigned to a group based on presence or absence of provider comments on discharge prescriptions. Outpatient pharmacy claims were compared with the discharge summary to identify medication discrepancies. Medication discrepancy rates between groups were to be compared by means of independent-samples t test. Medication discrepancy rates were compared according to 35-day readmission status, age group, and type of discrepancy by means of independent-samples t tests and analysis of variance. Descriptive statistics were used for other secondary outcomes.
Of 118 patients included, only 1 had provider comments. Therefore, a medication discrepancy rate comparison was not performed. Patients had a mean of 4 medication changes made to their regimen and 21.3% change in admission medications. Sixty-one percent of patients had at least 1 medication discrepancy, with an overall rate of 1.19. Patients readmitted within 35 days had a significantly greater medication discrepancy rate than those not readmitted (1.63 vs. 1.05, respectively; P = 0.044). Patients 18-49 years of age had the highest discrepancy rate and those older than 80 years of age the lowest (1.58 and 0.50, respectively). New or changed discharge medication not filled accounted for 69% of discrepancies.
Although medication discrepancies were common, use of provider comments was rare. Future studies should address more effective ways to communicate pertinent information to community pharmacists and methods to improve adherence in obtaining new medications.
比较出院时有无处方开具者注释的住院患者住院期间更改药物的人均差异率。次要目的包括比较35天再入院率，按年龄组和差异类型分层描述总体药物差异率，收集药物更改的平均次数，并报告出院时入院药物的百分比变化。
这项单中心前瞻性队列研究纳入了2015年11月1日至2016年1月31日从东卡罗来纳大学家庭医学服务部出院的北卡罗来纳医疗补助计划接受者。根据出院处方上有无开具者注释将患者分为两组。将门诊药房索赔与出院小结进行比较，以确定药物差异。采用独立样本t检验比较两组之间的药物差异率。通过独立样本t检验和方差分析，根据35天再入院状态、年龄组和差异类型比较药物差异率。对其他次要结局采用描述性统计。
纳入的118例患者中，只有1例有开具者注释。因此，未进行药物差异率比较。患者的治疗方案平均有4次药物更改，入院药物有21.3%的变化。61%的患者至少有1次药物差异，总体差异率为1.19。35天内再入院的患者的药物差异率显著高于未再入院的患者（分别为1.63和1.05；P = 0.044）。18至49岁的患者差异率最高，80岁以上的患者差异率最低（分别为1.58和0.50）。未取药的新的或更改的出院药物占差异的69%。
尽管药物差异很常见，但开具者注释的使用很少。未来的研究应探讨更有效的方法，以便与社区药剂师沟通相关信息，以及提高获取新药物依从性的方法。
