Laure Rouch,Toulouse University Hospital, Department of Pharmacy, France,
J Nutr Health Aging. 2018;22(3):328-334. doi: 10.1007/s12603-017-0940-1.
To evaluate the overall rate of adherence by general practitioners (GPs) to treatment modifications suggested at discharge from hospital and to assess the way communication between secondary and primary care could be improved.
Observational prospective cohort study.
Patients hospitalized from the emergency department to the acute geriatric care unit of a university hospital.
206 subjects with a mean age of 85 years.
Changes in drug regimen undertaken during hospitalization were collected with the associated justifications. Adherence at one month by GPs to treatment modifications was assessed as well as modifications implemented in primary care with their rationale in case of non-adherence. Community pharmacists' and GPs' opinions about quality of communication and information transfer at hospital-general practice interface were investigated.
5.5 ± 2.8 drug regimen changes were done per patient during hospitalization. The rate of adherence by GPs to treatment modifications suggested at discharge from hospital was 83%. In most cases, non-adherence by GPs to treatment modifications done during hospitalization was due to dosage adjustments, symptoms resolution but also worsening of symptoms. The last of which was particularly true for psychotropic drugs. All GPs received their patients' discharge letters but the timely dissemination still needs to be improved. Only 6.6% of community pharmacists were informed of treatment modifications done during their patients' hospitalization.
Our findings showed a successful rate of adherence by GPs to treatment modifications suggested at discharge from hospital, due to the fact that optimization was done in a collaborative way between geriatricians and hospital pharmacists and that justifications for drug regimen changes were systematically provided in discharge letters. Communication processes at the interface between secondary and primary care, particularly with community pharmacists, must be strengthened to improve seamless care.
评估全科医生（GP）对出院时建议的治疗调整的总体依从率，并评估如何改进二级和初级保健之间的沟通方式。
观察性前瞻性队列研究。
从急诊室住院到大学医院急性老年护理病房的患者。
206 名平均年龄为 85 岁的患者。
收集住院期间药物方案的变化，并附有相关的理由。评估 GP 在一个月内对治疗调整的依从性，以及在非依从性的情况下在初级保健中实施的调整及其理由。调查社区药剂师和全科医生对医院-全科医生接口处沟通和信息传递质量的看法。
每位患者在住院期间进行了 5.5 ± 2.8 次药物方案调整。出院时建议的治疗调整的 GP 依从率为 83%。在大多数情况下，GP 对住院期间进行的治疗调整不依从是由于剂量调整、症状缓解，但也由于症状恶化。对于精神药物尤其如此。所有 GP 都收到了他们患者的出院信，但及时传播仍有待改进。只有 6.6%的社区药剂师被告知他们患者在住院期间的治疗调整。
我们的研究结果表明，由于老年病学家和医院药剂师以协作的方式进行了优化，并且在出院信中系统地提供了药物方案变化的理由，因此 GP 对出院时建议的治疗调整的依从率很高。必须加强二级和初级保健之间的沟通流程，特别是与社区药剂师的沟通，以改善无缝护理。
