Hellemans Laura, Hias Julie, Walgraeve Karolien, Flamaing Johan, Spriet Isabel, Tournoy Jos, Van der Linden Lorenz
Hospital Pharmacy Department, University Hospitals Leuven, Herestraat 49, Leuven, 3000, Belgium.
Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium.
Int J Clin Pharm. 2020 Oct;42(5):1374-1378. doi: 10.1007/s11096-020-01091-4. Epub 2020 Aug 17.
Background Polypharmacy is prevalent in older adults and has been associated with iatrogenic harm. Deprescribing has been promoted to reduce polypharmacy. It remains however unclear whether deprescribing during hospital stay can reduce the readmission risk. Objective We sought to determine whether deprescribing in geriatric inpatients was associated with a lower readmission risk at three months post-discharge. Method A case control study was performed, using data from a prospective, controlled study in geriatric inpatients. Deprescribing was defined as the percentage of discontinued preadmission medications and was assessed upon discharge. A logistic regression analysis was used to determine the odds ratio for deprescribing and the outcome of readmissions. An adjusted odds ratio was then estimated, taking into account age, sex, mortality, the number of preadmission medications and the Charlson Comorbidity Index. Results Data of 166 patients were analysed, of whom 61 had experienced at least one readmission. Adjusting for age, number of preadmission medications and mortality resulted in the most informative regression model, based on the lowest Akaike information criterion (adjusted odds ratio 0.981, 95% confidence interval 0.964 to 0.998). Conclusion Deprescribing in geriatric inpatients was associated with a reduced readmission risk at three months post-discharge.Trial registration S53664.
背景 多重用药在老年人中很普遍,并且与医源性伤害有关。减药已被提倡用于减少多重用药。然而,住院期间减药是否能降低再入院风险仍不清楚。目的 我们试图确定老年住院患者减药是否与出院后三个月时较低的再入院风险相关。方法 进行了一项病例对照研究,使用来自老年住院患者前瞻性对照研究的数据。减药被定义为入院前停用药物的百分比,并在出院时进行评估。使用逻辑回归分析来确定减药的比值比和再入院结果。然后在考虑年龄、性别、死亡率、入院前用药数量和查尔森合并症指数的情况下估计调整后的比值比。结果 分析了166例患者的数据,其中61例至少有一次再入院经历。根据最低赤池信息准则,对年龄、入院前用药数量和死亡率进行调整后得到信息量最大的回归模型(调整后的比值比为0.981,95%置信区间为0.964至0.998)。结论 老年住院患者减药与出院后三个月时再入院风险降低相关。试验注册号S53664。