Lee Jonathan S, Gonzales Ralph, Vittinghoff Eric, Corbett Kitty K, Fleischmann Kirsten E, Sehgal Neil, Auerbach Andrew D
Division of General Internal Medicine, University of California San Francisco, San Francisco, California, USA.
Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA.
J Hosp Med. 2017 Sep;12(9):723-730. doi: 10.12788/jhm.2808.
To describe appropriate discharge reconciliation of cardiovascular medications and assess associations with postdischarge healthcare utilization in surgical patients.
Retrospective cohort study from January 2007 to December 2011.
An academic medical center.
Seven hundred and fifty-two adults undergoing elective noncardiac surgery and taking antiplatelet agents, beta-blockers, renin-angiotensin system inhibitors, or statin lipid-lowering agents before surgery.
Primary predictor: appropriate discharge reconciliation of preoperative cardiovascular medications (continuation without documented contraindications). Primary outcomes: acute hospital visits (emergency department visits or hospitalizations) and unplanned ambulatory visits (primary care or surgical) at 30 days after surgery.
Preoperative medications were appropriately reconciled in 436 (58.0%) patients. For individual medications, appropriate discharge reconciliation occurred for 156 of the 327 patients on antiplatelet agents (47.7%), 507 of the 624 patients on beta-blockers (81.3%), 259 of the 361 patients on renin-angiotensin system inhibitors (71.8%), and 302 of the 406 patients on statins (74.4%). In multivariable analyses, appropriate reconciliation of all preoperative medications was not associated with acute hospital (adjusted odds ratio [AOR], 0.94; 95% confidence interval [CI], 0.63-1.41) or unplanned ambulatory visits (AOR, 1.48; 95% CI, 0.94-2.35). Appropriate reconciliation of statin therapy was associated with lower odds of acute hospital visits (AOR, 0.47; 95% CI, 0.26-0.85). There were no other statistically significant associations between appropriate reconciliation of individual medications and either outcome.
Although large gaps in appropriate discharge reconciliation of chronic cardiovascular medications were common in patients undergoing elective surgery, these gaps were not consistently associated with postdischarge acute hospital or ambulatory visits.
描述心血管药物出院时的合理核对情况，并评估其与外科手术患者出院后医疗保健利用情况的相关性。
2007年1月至2011年12月的回顾性队列研究。
一所学术医疗中心。
752例接受择期非心脏手术且术前服用抗血小板药物、β受体阻滞剂、肾素-血管紧张素系统抑制剂或他汀类降脂药物的成年人。
主要预测因素：术前心血管药物的合理出院核对（在无记录的禁忌证情况下继续用药）。主要结局：术后30天内的急性医院就诊（急诊就诊或住院）和非计划门诊就诊（初级保健或外科）。
436例（58.0%）患者的术前用药得到了合理核对。对于个别药物，327例服用抗血小板药物的患者中有156例（47.7%）出院时合理核对，624例服用β受体阻滞剂的患者中有507例（81.3%），361例服用肾素-血管紧张素系统抑制剂的患者中有259例（71.8%），406例服用他汀类药物的患者中有302例（74.4%）。在多变量分析中，所有术前用药的合理核对与急性医院就诊（调整后的优势比[AOR]，0.94；95%置信区间[CI]，0.63 - 1.41）或非计划门诊就诊（AOR，1.48；95% CI，0.94 - 2.35）均无关联。他汀类药物治疗的合理核对与急性医院就诊几率较低相关（AOR，0.47；95% CI，0.26 - 0.85）。个别药物的合理核对与任何一种结局之间均无其他具有统计学意义的关联。
尽管在接受择期手术的患者中，慢性心血管药物出院时的合理核对存在较大差距很常见，但这些差距与出院后的急性医院就诊或门诊就诊并无一致关联。
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