Hospital Pharmacy Department, Uppsala University Hospital, SE-751 85, Uppsala, Sweden.
Department of Pharmacy, Uppsala University, Uppsala, Sweden.
BMC Geriatr. 2021 Nov 2;21(1):618. doi: 10.1186/s12877-021-02564-5.
The discharge of older hospitalised patients is critical in terms of patient safety. Inadequate transfer of information about medications to the next healthcare provider is a known problem, but there is a lack of understanding of this problem in settings where shared electronic health records are used. The aims of this study were to evaluate the prevalence of patients for whom hospitals sent adequate requests for medication-related follow-up at discharge, the proportion of patients with unplanned hospital revisits because of inadequate follow-up requests, and the association between medication reviews performed during hospitalisation and adequate or inadequate follow-up requests.
We conducted a retrospective chart review. The study population was randomly selected from a cluster-randomised crossover trial which included patients 65 years or older who had been admitted to three hospitals in Sweden with shared electronic health records between hospital and primary care. Each patient was assessed with respect to the adequacy of the request for follow-up. For patients where the hospitals sent inadequate requests, data about any unplanned hospital revisits were collected, and we assessed whether the inadequate requests had contributed to the revisits. The association between medication reviews and adequate or inadequate requests was analysed with a Chi-square test.
A total of 699 patients were included. The patients' mean age was 80 years; an average of 10 medications each were prescribed on hospital admission. The hospitals sent an adequate request for 418 (60%) patients. Thirty-eight patients (14%) had a hospital revisit within six months of discharge which was related to an inadequate request. The proportion of adequate or inadequate requests did not differ between patients who had received a medication review during hospitalisation and those who had not (p = 0.83).
The prevalence of patients for whom the hospitals sent adequate follow-up requests on discharge was low. More than one in every ten who had an inadequate request revisited hospital within six months of discharge for reasons related to the request. Medication reviews conducted during hospitalisation did not affect the proportion of adequate or inadequate requests sent. A communication gap still exists despite the usage of a shared electronic health record between primary and secondary care levels.
老年住院患者出院时的情况对患者安全至关重要。向下一个医疗服务提供者传递药物信息不足是一个已知的问题，但在使用共享电子健康记录的环境中，人们对此问题缺乏了解。本研究的目的是评估医院在出院时发送足够的药物相关随访请求的患者比例、因随访请求不足而导致计划外医院复诊的患者比例，以及住院期间进行的药物审查与适当或不适当的随访请求之间的关系。
我们进行了回顾性病历审查。研究人群是从一项包括瑞典三家医院的电子病历的随机对照交叉试验中随机选择的，该试验包括 65 岁及以上的患者，这些患者在医院和初级保健之间使用了共享电子健康记录。每个患者都评估了随访请求的充分性。对于医院发送的不充分请求的患者，收集了任何计划外医院复诊的数据，并评估了不充分请求是否导致了复诊。使用卡方检验分析药物审查与适当或不适当请求之间的关联。
共纳入 699 例患者。患者的平均年龄为 80 岁；入院时平均每人服用 10 种药物。医院向 418 名（60%）患者发送了适当的随访请求。38 名（14%）患者在出院后 6 个月内因与请求相关的原因再次住院。在住院期间接受药物审查的患者和未接受药物审查的患者之间，适当或不适当请求的比例没有差异（p=0.83）。
医院在出院时发送适当随访请求的患者比例较低。每十个不充分请求中就有一个以上的患者在出院后 6 个月内因与请求相关的原因再次住院。在住院期间进行的药物审查并没有影响发送的适当或不适当请求的比例。尽管在初级保健和二级保健之间使用了共享电子健康记录，但仍然存在沟通差距。
