School of Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia.
School of Pharmacy, Faculty of Science, University of Utrecht, Utrecht, The Netherlands.
J Gen Intern Med. 2021 May;36(5):1371-1379. doi: 10.1007/s11606-020-06442-5. Epub 2021 Feb 3.
Hospital discharge has a significant impact on the continuity of care for people living with dementia. Clear guidance on medication management should be provided to caregivers of people living with dementia to ensure appropriate use of medications post-discharge.
Identify and appraise the impact of interventions at hospital discharge to guide caregivers in the medication management for people living with dementia.
A systematic search of original studies was performed in Medline, Embase, PsycINFO, and CINAHL. Articles published in English that reported on interventions to guide caregivers in medication management for people living with dementia were included. Two authors independently reviewed titles and abstract. Full-text articles were assessed for eligibility and quality assessment was conducted by two authors.
A total of five studies were included with a range of interventions that were typically delivered post-discharge by a multidisciplinary team and most targeted administration of medications by caregivers. Overall, three types of discharge interventions were identified including a pre-discharge caregiver educational intervention, a post-discharge multidisciplinary team intervention, and discharge summary documentation intervention at transitions of care. Of these, a pre-discharge caregiver education led to shorter hospital stay (25 days vs. 31 days, p = 0.005). A post-discharge intervention that included follow-up visits resulted in lower use of high-risk medications (19% vs. 40%), and reduction in 30-day re-hospitalization rates (11% vs. 20%). In contrast, in another post-discharge intervention study, no difference in one-month re-hospitalization rates (8.4% vs. 8.0%, p = 0.82) was demonstrated. In another study, a post-discharge hospital educational program provided to caregivers led to significantly reduced caregiver burden (31.7 ± 17.6 (SD) pre-intervention to 27.7 ± 16.9 (SD) post-intervention (p = 0.037)).
Current findings suggest there is a need for well-designed interventions to guide caregivers in all aspects of medication management for people living with dementia, and should include support for caregivers in care coordination.
医院出院对痴呆症患者的连续护理有重大影响。应为痴呆症患者的护理人员提供明确的药物管理指导，以确保出院后适当使用药物。
确定并评估出院干预措施对指导痴呆症患者护理人员进行药物管理的影响。
对 Medline、Embase、PsycINFO 和 CINAHL 中的原始研究进行系统检索。纳入了报告旨在指导痴呆症患者护理人员进行药物管理的干预措施的以英文发表的文章。两名作者独立审查标题和摘要。评估全文文章的合格性，并由两名作者进行质量评估。
共纳入了五项研究，干预措施范围广泛，通常由多学科团队在出院后提供，且大多数针对护理人员的药物管理。总体而言，确定了三种出院干预措施，包括出院前护理人员教育干预、出院后多学科团队干预以及在护理交接时的出院总结文件干预。其中，出院前护理人员教育可使住院时间缩短（25 天比 31 天，p = 0.005）。包括随访的出院干预措施可降低高风险药物的使用（19%比 40%），并降低 30 天内再住院率（11%比 20%）。相比之下，在另一项出院后干预研究中，一个月内再住院率没有差异（8.4%比 8.0%，p = 0.82）。在另一项研究中，为护理人员提供的出院后医院教育计划可显著降低护理人员的负担（干预前 31.7 ± 17.6（SD）降至干预后 27.7 ± 16.9（SD）（p = 0.037））。
目前的研究结果表明，需要设计良好的干预措施来指导痴呆症患者的护理人员进行药物管理的各个方面，并且应该包括对护理人员在协调护理方面的支持。
