Wilke Dominik, Schiek Susanne, Knoth Holger, Bertsche Thilo
Klinik-Apotheke, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden AöR, Dresden (Germany).
Universität und Universitätsklinikum Leipzig AöR, Medizinische Fakultät, ZAMS - Zentrum für Arzneimittelsicherheit, Leipzig (Germany).
Dtsch Med Wochenschr. 2018 Jul;143(14):e117-e124. doi: 10.1055/a-0595-6345. Epub 2018 Jul 13.
Changes in drug therapy at intersectoral interfaces can lead to clinically relevant drug-related problems. This study aimed, therefore, at comparing the drug prescription continuity of patients with and without a medication plan at hospital admission.
After ethical approval, patients of a health insurance company in 6 hospitals in Saxony were consecutively assigned to this study from November 2011 to January 2012 after written informed consent. We assessed the following drug-related data for patients with and without medication plan at hospital admission: (i) the medication prescribed by the hospital physician on the day of hospital admission and (ii) the medication of the hospital discharge letter. Patient-individual claims data were assigned to the inpatient data for a period of 6 months before and after inpatient treatment (data linkage).
Of the 279 study participants, 173 (62 %) used a medication plan at hospital admission. Patients with a medication plan had a statistically significantly older age, higher numbers of drugs and diagnoses and fewer emergency admissions. At admission 53 % of the drugs were continued in patients with medication plan and 40 % in patients without a medication plan (p < 0.001). At hospital discharge 66 % and 64 % were continued after discharge (n. s.). Medication plans were mostly written by their GP (38 %) and in 12 % by the patients themselves.
Even before implementation of the national medication plan, nearly two third of the patients had a medication plan at hospital admission. However, in many cases it had been prepared by the patients themselves. The existence of a medication plan can have an impact on the continuity of the drug prescription during hospitalisation but not after discharge.
跨部门交接时药物治疗的变化可能导致具有临床相关性的药物相关问题。因此，本研究旨在比较入院时有无用药计划的患者的药物处方连续性。
在获得伦理批准后，2011年11月至2012年1月期间，萨克森州6家医院的一家健康保险公司的患者在签署书面知情同意书后被连续纳入本研究。我们评估了入院时有无用药计划的患者的以下药物相关数据：（i）入院当天医院医生开具的药物处方，以及（ii）出院小结中的药物。将患者个体索赔数据与住院治疗前后6个月的住院患者数据进行关联（数据链接）。
在279名研究参与者中，173名（62%）在入院时使用了用药计划。有用药计划的患者在统计学上年龄显著更大，使用的药物和诊断数量更多，急诊入院次数更少。入院时，有用药计划的患者中53%的药物得以继续使用，无用药计划的患者中这一比例为40%（p<0.001）。出院时，出院后继续用药的比例分别为66%和64%（无显著差异）。用药计划大多由其家庭医生制定（38%），12%由患者自己制定。
即使在国家用药计划实施之前，近三分之二的患者在入院时就有用药计划。然而，在许多情况下，用药计划是由患者自己制定的。用药计划的存在可能会对住院期间药物处方的连续性产生影响，但对出院后则无影响。
