Vranian Steven Craig, Covert Kelly L, Mardis Caitlin R, McGillicuddy John W, Chavin Kenneth D, Dubay Derek, Taber David J
Division of Transplant Surgery, Medical University of South Carolina, Charleston, South Carolina.
College of Pharmacy, Bill Gatton College of Pharmacy, Johnson City, Tennessee.
J Surg Res. 2018 Feb;222:195-202.e2. doi: 10.1016/j.jss.2017.09.037.
There are only a limited number of studies that have sought to identify patients at high risk for medication errors and subsequent adverse clinical outcomes. This study sought to identify risk factors for increased health care resource utilization in kidney transplant recipients based on drug-related problems and self-administered surveys.
In this prospective observational study, adult kidney transplant recipients seen in the transplant clinic between September and November 2015 were surveyed for self-reported demographics, medication adherence, and health status/outlook. Subsequently, patients were assessed for associations between survey results, pharmacist-derived drug-related problems, and health resource utilization over a minimum 6-mo follow-up period. Based on univariate associations, two risk cohorts were identified and compared for health care utilization using multivariable Poisson regression.
A total of 237 patients were included, with a mean follow-up of 8 mo. From the patient survey data, Medicaid insured or self-rated poor health status were identified as a significant risk cohort. From pharmacist assessments, those who received incorrect medication or lacked appropriate follow-up medication monitoring were identified as a significant risk cohort (pharmacy errors). The Medicaid insured or self-rated poor health status cohort experienced 43% more total health care encounters (incident rate ratios [IRR] 1.43, 1.01-2.02) and 35% more transplant clinic visits (IRR 1.35, 1.03-1.77). The pharmacy errors cohort experienced 4.2 times the rate of total health care encounters (IRR 4.17, 1.55-11.2), 4.1 times the rate of hospital readmissions (IRR 4.09, 1.58-10.6), and 2.3 times the rate of transplant clinic visits (IRR 2.31, 1.04-5.11).
Medicaid insurance, self-rated poor health status, and errors in the medication regimen or monitoring were significant risk factors for increased health care utilization in kidney transplant recipients. Further research is warranted to validate these potential risk factors, determine the long-term impact on graft/patient survival, and assess the mutability of these risks through prospective identification and intervention.
仅有少数研究试图确定用药错误及随后不良临床结局的高风险患者。本研究旨在基于药物相关问题和自我管理调查确定肾移植受者医疗资源利用增加的风险因素。
在这项前瞻性观察研究中，对2015年9月至11月在移植诊所就诊的成年肾移植受者进行了自我报告的人口统计学、用药依从性及健康状况/前景的调查。随后，在至少6个月的随访期内评估患者的调查结果、药剂师发现的药物相关问题与医疗资源利用之间的关联。基于单变量关联，确定了两个风险队列，并使用多变量泊松回归比较了它们的医疗利用情况。
共纳入237例患者，平均随访8个月。从患者调查数据中，医疗补助保险参保者或自我评定健康状况差被确定为一个显著风险队列。从药剂师评估中，接受错误药物治疗或缺乏适当随访药物监测的患者被确定为一个显著风险队列（药房错误）。医疗补助保险参保者或自我评定健康状况差的队列总医疗就诊次数多43%（发病率比[IRR]1.43，1.01 - 2.02），移植诊所就诊次数多35%（IRR 1.35，1.03 - 1.77）。药房错误队列的总医疗就诊率是4.2倍（IRR 4.17，1.55 - 11.2），医院再入院率是4.1倍（IRR 4.09，1.58 - 10.6），移植诊所就诊率是2.3倍（IRR 2.31，1.04 - 5.11）。
医疗补助保险、自我评定健康状况差以及药物治疗方案或监测中的错误是肾移植受者医疗利用增加的显著风险因素。有必要进行进一步研究以验证这些潜在风险因素，确定其对移植物/患者存活的长期影响，并通过前瞻性识别和干预评估这些风险的可变性。
