Cheong V-Lin, Sowter Julie, Scally Andy, Hamilton Neil, Ali Ali, Silcock Jonathan
University of Bradford, School of Pharmacy and Medical Sciences, Bradford, UK; Sheffield Teaching Hospitals Foundation Trust, Pharmacy Department, UK.
University of Bradford, School of Pharmacy and Medical Sciences, Bradford, UK.
Res Social Adm Pharm. 2020 Sep;16(9):1318-1322. doi: 10.1016/j.sapharm.2019.02.001. Epub 2019 Feb 14.
Repeated hospital admissions are prevalent in older people. The role of medication in repeated hospital admissions has not been widely studied. The hypothesis that medication-related risk factors for initial hospital admissions were also associated with repeated hospital admissions was generated.
To examine the association between medication-related risk factors and repeated hospital admissions in older people living with frailty.
A retrospective case-control study was carried out with 200 patients aged ≥75 years with unplanned medical admissions into a large teaching hospital in England between January and December 2015. Demographic, clinical, and medication-related data were obtained from review of discharge summaries. Statistical comparisons were made between patients with 3 or more hospital admissions during the study period (cases) and those with 2 or fewer admissions (controls). Regressions were performed to establish independent predictors of repeated hospital admissions.
Participants had a mean age of 83.8 years (SD 5.68) and 65.5% were female. There were 561 admission episodes across the sample, with the main reasons for admissions recorded as respiratory problems (25%) and falls (17%). Univariate logistic regression revealed five medication-related risks to be associated with repeated hospital admissions: Hyper-polypharmacy (defined as taking ≥10 medications) (OR 2.50, p < 0.005); prescription of potentially inappropriate medications (PIMs) (OR 1.89; p < 0.05); prescription of a diuretic (OR 1.87; p < 0.05); number of high risk medication (OR 1.29; p < 0.05) and the number of 'when required' medication (OR 1.20; p < 0.05). However, the effects of these risk factors became insignificant when comorbid disease was adjusted for in a multivariable model.
Medication-related risk factors may play an important role in future repeated admission risk prediction models. The modifiable nature of medication-related risks factors highlights a real opportunity to improve health outcomes.
反复住院在老年人中很常见。药物治疗在反复住院中的作用尚未得到广泛研究。由此产生了一种假设，即初次住院的药物相关风险因素也与反复住院有关。
研究药物相关风险因素与体弱老年人反复住院之间的关联。
进行了一项回顾性病例对照研究，研究对象为2015年1月至12月间在英国一家大型教学医院非计划入院的200名年龄≥75岁的患者。通过查阅出院小结获取人口统计学、临床和药物相关数据。对研究期间住院3次或以上的患者（病例组）和住院2次或以下的患者（对照组）进行统计比较。进行回归分析以确定反复住院的独立预测因素。
参与者的平均年龄为83.8岁（标准差5.68），65.5%为女性。样本中共有561次入院记录，主要入院原因记录为呼吸问题（25%）和跌倒（共17%）。单因素逻辑回归显示，有五个药物相关风险与反复住院有关：多重用药（定义为服用≥10种药物）（比值比2.50，p<0.005）；开具潜在不适当药物（PIMs）（比值比1.89；p<0.05）；开具利尿剂（比值比1.87；p<0.05）；高风险药物数量（比值比1. ; p<0.05）和“按需”用药数量（比值比1.20；p<0.05）。然而，在多变量模型中对合并症进行调整后，这些风险因素影响变得不显著。
药物相关风险因素可能在未来反复入院风险预测模型中发挥重要作用。药物相关风险因素具有可改变的性质，这凸显了改善健康结局的切实机会。
