老年人对急诊科出院医嘱遵从性的预测因素。
Predictors of Older Adult Adherence With Emergency Department Discharge Instructions.
机构信息
From the, Department of Health Policy and Management, School of Public Health, University of Maryland, College Park, MD, USA.
the, Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.
出版信息
Acad Emerg Med. 2021 Feb;28(2):215-225. doi: 10.1111/acem.14105. Epub 2020 Sep 7.
OBJECTIVE
Older adults discharged from the emergency department (ED) are at high risk for adverse outcomes. Adherence to ED discharge instructions is necessary to reduce those risks. The objective of this study is to determine the individual-level factors associated with adherence with ED discharge instructions among older adult ED outpatients.
METHODS
We performed a secondary analysis of data from the control group of a randomized controlled trial testing a care transitions intervention among older adults (age ≥ 60 years) discharged home from the ED in two states. Taking data from patient surveys and chart reviews, we used multivariable logistic regression to identify patient characteristics associated with adherence to printed discharge instructions. Outcomes were patient-reported medication adherence, provider follow-up visit adherence, and knowledge of "red flags" (signs of worsening health requiring further medical attention).
RESULTS
A total 824 patients were potentially eligible, and 699 had data in at least one pillar. A total of 35% adhered to medication instructions, 76% adhered to follow-up instructions, and 35% recalled at least one red flag. In the multivariate analysis, no factors were significantly associated with failure to adhere to medications. Participants with poor health status (adjusted odds ratio [AOR] = 0.55, 95% confidence interval [CI] = 0.31 to 0.98) were less likely to adhere to follow-up instructions. Participants who were older (AORs trended downward as age category increased) or depressed (AOR = 0.39, 95% CI = 0.17 to 0.85) or had one or more functional limitations (AOR = 0.62, 95% CI = 0.41 to 0.94) were less likely to recall red flags.
CONCLUSION
Older adults discharged home from the ED have mixed rates of adherence to discharge instructions. Although it is thought that some subgroups may be higher risk than others, given the opportunity to improve ED-to-home transitions, EDs and health systems should consider providing additional care transition support to all older adults discharged home from the ED.
目的
从急诊科（ED）出院的老年人存在发生不良后果的高风险。为了降低这些风险，必须遵守 ED 出院医嘱。本研究的目的是确定与 ED 门诊老年患者出院医嘱遵从性相关的个体水平因素。
方法
我们对在两个州从 ED 出院回家的老年人（年龄≥60 岁）的一项随机对照试验的对照组数据进行了二次分析。通过患者调查和病历回顾获取数据，我们使用多变量逻辑回归确定与遵从打印的出院医嘱相关的患者特征。结局指标为患者报告的药物遵从性、医生随访访问遵从性和对“危险信号”（健康状况恶化需要进一步医疗关注的迹象）的了解。
结果
共有 824 名患者可能符合入选条件，699 名患者至少在一个支柱中有数据。共有 35%的患者遵从药物医嘱，76%的患者遵从随访医嘱，35%的患者至少回忆起一个危险信号。在多变量分析中，没有因素与未能遵从药物治疗显著相关。健康状况较差的患者（调整后的优势比[OR] = 0.55，95%置信区间[CI] = 0.31 至 0.98）不太可能遵从随访医嘱。年龄较大的患者（随着年龄组的增加，OR 呈下降趋势）或抑郁的患者（OR = 0.39，95%CI = 0.17 至 0.85）或有一个或多个功能障碍的患者（OR = 0.62，95%CI = 0.41 至 0.94）不太可能回忆起危险信号。
结论
从 ED 出院回家的老年人遵从出院医嘱的比例参差不齐。尽管一些亚组可能比其他亚组风险更高，但 ED 和医疗系统应该考虑为所有从 ED 出院回家的老年人提供额外的过渡护理支持，以利用改善 ED 到家庭过渡的机会。
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