Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
Dartmouth Centers for Health and Aging, Lebanon, NH, USA.
J Gen Intern Med. 2017 Dec;32(12):1301-1308. doi: 10.1007/s11606-017-4157-0. Epub 2017 Aug 28.
Hospitalizations and potentially inappropriate medication (PIM) use are significant and costly issues among older home health patients, yet little is known about the prevalence of PIM use in home health or the relationship between PIM use and hospitalization risk in this population.
To describe the prevalence of PIM use and association with hospitalization among Medicare home health patients.
Cross-sectional analysis using data from 132 home health agencies in the US.
Medicare beneficiaries starting home health nursing services between 2013 and 2014 (n = 87,780).
Prevalence of individual and aggregate PIM use at start of care, measured using the 2012 Beers criteria. Relative risk (RR) of 30-day hospitalization or re-hospitalization associated with individual and aggregate PIM use, compared to no PIM use.
In total, 30,168 (34.4%) patients were using at least one PIM, with 5969 (6.8%) taking at least two PIMs according to the Beers list. The most common types of PIMs were those affecting the brain or spinal cord, analgesics, and medications with anticholinergic properties. With the exception of nonsteroidal anti-inflammatory drugs (NSAIDs), PIM use across all classes was associated with elevated risk (10-33%) of hospitalization compared to non-use. Adjusting for demographic and clinical characteristics, patients using at least one PIM (excluding NSAIDs) had a 13% greater risk (RR = 1.13, 95% CI: 1.09, 1.17) of being hospitalized than patients using no PIMs, while patients using at least two PIMs had 21% greater risk (RR = 1.21, 95% CI: 1.12, 1.30). Similar associations were found between PIMs and re-hospitalization risk among patients referred to home health from a hospital.
Given the high prevalence of PIM use and the association between PIMs and hospitalization risk, home health episodes represent opportunities to substantially reduce PIM use among older adults and prevent adverse outcomes. Efforts to address medication use during home health episodes, hospitalizations, and care transitions are justified.
在老年家庭保健患者中，住院和潜在不适当用药（PIM）的使用是一个重大且代价高昂的问题，但人们对家庭保健中 PIM 使用的流行程度以及在该人群中 PIM 使用与住院风险之间的关系知之甚少。
描述 Medicare 家庭保健患者中 PIM 使用的流行程度及其与住院的关系。
使用来自美国 132 个家庭保健机构的数据进行横断面分析。
2013 年至 2014 年期间开始家庭保健护理服务的 Medicare 受益人（n=87780）。
使用 2012 年 Beers 标准测量护理开始时个体和总体 PIM 使用的流行程度。与不使用 PIM 相比，个体和总体 PIM 使用与 30 天内住院或再次住院的相对风险（RR）。
总共有 30168（34.4%）名患者至少使用一种 PIM，其中根据 Beers 清单，有 5969（6.8%）名患者至少使用两种 PIM。最常见的 PIM 类型是影响大脑或脊髓、镇痛药和具有抗胆碱能特性的药物。除非甾体抗炎药（NSAIDs）外，所有类别 PIM 的使用与住院风险升高（10-33%）相关，而非不使用。在调整人口统计学和临床特征后，与不使用 PIM 的患者相比，至少使用一种 PIM（不包括 NSAIDs）的患者住院风险增加 13%（RR=1.13，95%CI：1.09，1.17），而至少使用两种 PIM 的患者住院风险增加 21%（RR=1.21，95%CI：1.12，1.30）。在从医院转介到家庭保健的患者中，也发现了 PIM 与再住院风险之间的类似关联。
鉴于 PIM 使用的高流行率以及 PIM 与住院风险之间的关联，家庭保健发作为大幅减少老年人中 PIM 使用和预防不良结局提供了机会。有理由努力解决家庭保健发作期间、住院期间和护理过渡期间的药物使用问题。
