Hammouda Nada, Vargas-Torres Carmen, Doucette John, Hwang Ula
Department of Emergency Medicine, Mount Sinai School of Medicine, New York City, USA.
Department of Emergency Medicine, Mount Sinai School of Medicine, New York City, USA.
Am J Emerg Med. 2021 Jun;44:148-156. doi: 10.1016/j.ajem.2021.02.004. Epub 2021 Feb 5.
To determine whether Potentially Inappropriate Medications (PIMs) prescribed in an academic emergency department (ED) are associated with increased ED revisits in older adults.
A retrospective chart review of Medicare beneficiaries 65 years and older, discharged from an academic ED (January 2012 - November 2015) with any PIMs versus no PIMs. PIMs were defined using Category 1 of the 2015 Updated Beers criteria. Primary outcomes, obtained from a Medicare database linked to hospital ED subjects, were ED revisits 3 and 30 days from index ED discharge. Adjusted multiple logistic regression was used with entropy balance weighted covariates: Age in years, Gender, Race, Number of discharge medications, Charlson Comorbidity Index (CCI) score, Emergency Severity Index scores (ESI), Chief Complaint, Medicaid status, and prior 90 Day ED visits.
Over the study period, there were a total of 7,591 Medicare beneficiaries 65+ discharged from the ED with a prescription; 1,383 (18%) received one or more PIMs. ED revisits in 30 days were fewer for the PIMs cohort (12% PIMs vs 16% no PIMs, OR 0.79, 95% CI 0.65 - 0.95, P value <0.005). Hospital admissions in 30 days were fewer for the PIMs cohort (4 PIMs vs 7% no PIMs, OR 0.75, 95% CI 0.56 - 1.00, P value <0.005). In addition to PIMs, covariate risk factors associated with ED revisits in 30 days included comorbidity severity, history of prior ED revisits, chief complaint, and Medicaid status. Risk factors associated with hospitalization in 30 days included those plus age and emergency severity index, but not race nor ethnicity.
Patients discharged from the ED receiving potentially inappropriate medications as defined by Category 1 of the 2015 updated Beers criteria had lower odds of revisiting the ED within 30 days of index visit. Sociodemographic factors such as gender and race did not predict ED revisits or hospital admissions. Clinical characteristics predicted ED revisits and hospital admissions, the strongest risk being increasing Charlson Comorbidity Index score followed by triage acuity and chief complaint. Future studies are needed to delineate the implications of our findings.
确定在学术性急诊科（ED）开具的潜在不适当用药（PIMs）是否与老年人急诊复诊次数增加相关。
对2012年1月至2015年11月从学术性急诊科出院的65岁及以上医疗保险受益人进行回顾性病历审查，比较开具了任何PIMs与未开具PIMs的情况。PIMs使用2015年更新的《Beers标准》第1类进行定义。主要结局从与医院急诊科受试者相关联的医疗保险数据库中获取，为首次急诊科出院后3天和30天的急诊复诊情况。采用调整后的多元逻辑回归分析，并使用熵平衡加权协变量：年龄（岁）、性别、种族、出院用药数量、Charlson合并症指数（CCI）评分、急诊严重程度指数（ESI）评分、主要诉求、医疗补助状态以及之前90天内的急诊科就诊次数。
在研究期间，共有7591名65岁及以上的医疗保险受益人从急诊科出院并开具了处方；其中1383人（18%）接受了一种或多种PIMs。PIMs组在30天内的急诊复诊次数较少（PIMs组为12%，未开具PIMs组为16%，比值比[OR]为0.79，95%置信区间[CI]为0.65 - 0.95，P值<0.005）。PIMs组在30天内的住院人数较少（PIMs组为4%，未开具PIMs组为7%，OR为0.75，95%CI为0.56 - 1.00，P值<0.005）。除PIMs外，与30天内急诊复诊相关的协变量风险因素包括合并症严重程度、之前急诊复诊史、主要诉求和医疗补助状态。与30天内住院相关的风险因素包括上述因素以及年龄和急诊严重程度指数，但不包括种族和民族。
按照2015年更新的《Beers标准》第1类定义，从急诊科出院时接受潜在不适当用药的患者，在首次就诊后30天内再次前往急诊科的几率较低。性别和种族等社会人口学因素并不能预测急诊复诊或住院情况。临床特征可预测急诊复诊和住院情况，最强的风险因素是Charlson合并症指数评分增加，其次是分诊 acuity和主要诉求。需要进一步研究来阐明我们研究结果的意义。
Zotero 插件