Bonaudo Marco, Martorana Maria, Dimonte Valerio, D'Alfonso Alessandra, Fornero Giulio, Politano Gianfranco, Gianino Maria Michela
Department of Public Health Sciences and Pediatrics, Università di Torino, Torino, Italy.
Public Health Authority, ASLTO2, Torino, Italy.
PLoS One. 2018 Jan 12;13(1):e0191028. doi: 10.1371/journal.pone.0191028. eCollection 2018.
Medication discrepancies are defined as unexplained differences among regimens across different sites of care. The problem of medication discrepancies that occur during the entire care pathway from hospital admission to a local care setting discharge (namely all types of settings dedicated to formal care other than hospitals) has received little attention in the medical literature. The present study aims to (1) determine the prevalence of medication discrepancies that occur during the entire care pathway from hospital admission to local care setting discharge, (2) describe the discrepancy and medication type, and (3) identify potential risk factors for experiencing medication discrepancies in patient care transitions. Evidence from an integrated health care system, such as the Italian one, may explain results from other studies in different healthcare systems.
A retrospective longitudinal cohort study of patients admitted from July 2015 to July 2016 to the Giovanni Bosco Hospital serving Turin, Italy and its surrounding territory was performed. Discrepancies were recorded at the following four care transitions: T1: Hospital admission; T2: Hospital discharge; T3: Admission into local care settings; T4: Discharge from local care settings. All evaluations were based on documented regimens and were performed by a team (doctor, nurse and pharmacists).
Of 366 included patients, 25.68% had at least one discrepancy. The most frequent type of discrepancy was from medication omission (N = 74; 71.15%). Only discharge from a long-stay care setting (T4) was significantly associated with the onset of discrepancies (p = 0.045). When considering a lack of adequate documentation, not as missing data but as a discrepancy, 43.72% of patients had at least one discrepancy.
This study suggests that an integrated health care system, such as Italian system, may influence the prevalence of discrepancies, thus highlighting the need for structured multidisciplinary and, if possible, computerized medication reconciliation to prevent medication discrepancies and improve the quality of medical documentation.
用药差异被定义为不同护理场所的治疗方案之间无法解释的差异。从医院入院到当地护理机构出院（即除医院外所有致力于正规护理的场所类型）的整个护理过程中出现的用药差异问题在医学文献中很少受到关注。本研究旨在：（1）确定从医院入院到当地护理机构出院的整个护理过程中出现的用药差异的发生率；（2）描述差异和用药类型；（3）确定患者护理转接过程中出现用药差异的潜在风险因素。来自综合医疗保健系统（如意大利的系统）的证据可能解释不同医疗保健系统中其他研究的结果。
对2015年7月至2016年7月入住意大利都灵及其周边地区的乔瓦尼·博斯科医院的患者进行回顾性纵向队列研究。在以下四个护理转接点记录差异：T1：医院入院；T2：医院出院；T3：入住当地护理机构；T4：从当地护理机构出院。所有评估均基于记录的治疗方案，由一个团队（医生、护士和药剂师）进行。
在366名纳入研究的患者中，25.68%至少有一处差异。最常见的差异类型是用药遗漏（N = 74；71.15%）。只有从长期护理机构出院（T4）与差异的出现显著相关（p = 0.045）。当将缺乏充分记录视为差异而非缺失数据时，43.72%的患者至少有一处差异。
本研究表明，像意大利系统这样的综合医疗保健系统可能会影响差异的发生率，从而凸显了进行结构化多学科以及可能的计算机化用药核对以预防用药差异并提高医疗记录质量的必要性。
