Ibarra Mira María Luisa, Caro-Teller Jose Manuel, Rodríguez Quesada Pedro Pablo, Garcia-Muñoz Carmen, Añino Alba Almudena, Ferrari Piquero Jose Miguel
Hospital Universitario 12 de Octubre, Madrid, Spain.
Servicio Madrileño de Salud, Madrid, Spain.
J Pharm Technol. 2021 Dec;37(6):310-315. doi: 10.1177/87551225211047607. Epub 2021 Sep 22.
A significant percentage of hospital readmissions within 30 days of discharge are a result of avoidable drug-related problems. Stratifying patients according to readmission risk is key to pharmaceutical intervention (PI) design strategies to improve treatment outcomes. To assess whether a pharmaceutical care (PC) program at discharge in polymedicated patients at high potentially avoidable readmission (PAR) risk, according to the HOSPITAL score, improves 30-day readmission rate (30-dRR). This prospective controlled, quasi-experimental, 11-month study included 163 chronic polymedicated patients (>5 medications) at high PAR risk according to the HOSPITAL score. We calculated the 30-dRR and number of medication variations and Medication Regimen Complexity Index-E (MRCI-E) after PI. Results were compared with a retrospective cohort of chronic patients at high PAR risk. The 30-dRR was 18.4% in the intervention group and 25.6% in the control group (odds ratio [OR] = 0.66; 95% CI = 0.38 to 1.14). Total medication reduction (-1.28; 95% CI = -1.88 to -0.68), number of high-risk medications in chronic patients (-0.58; 95% CI = -0.9 to -0.26), and MRCI-E (-6.42; 95% CI = -8.07 to -4.76) were statistically significant ( < .001). The number of medications at discharge was associated with an increased readmission risk (OR = 1.07; 95% CI = 1.01 to 1.14). The degree of polypharmacy and patients' treatment complexity after hospital discharge significantly reduced as a result of the PC program compared with the control group. This highlights the need for patient selection and prioritization strategies for implementing PIs focused on reducing polypharmacy and preventing drug-related problems that may cause PAR.
出院后30天内相当大比例的医院再入院是由可避免的药物相关问题导致的。根据再入院风险对患者进行分层是改善治疗结果的药物干预（PI）设计策略的关键。为了评估根据医院评分，在具有高潜在可避免再入院（PAR）风险的多药治疗患者出院时实施的药学服务（PC）项目是否能提高30天再入院率（30-dRR）。这项前瞻性对照、准实验性、为期11个月的研究纳入了163名根据医院评分具有高PAR风险的慢性多药治疗患者（服用超过5种药物）。我们计算了PI后的30-dRR、药物变更数量和药物治疗方案复杂性指数-E（MRCI-E）。结果与一组具有高PAR风险的慢性患者回顾性队列进行了比较。干预组的30-dRR为18.4%，对照组为25.6%（优势比[OR]=0.66；95%置信区间[CI]=0.38至1.14）。药物总量减少（-1.28；95%CI=-1.88至-0.68）、慢性患者中高风险药物数量（-0.58；95%CI=-0.9至-0.26）和MRCI-E（-6.42；95%CI=-8.07至-4.76）具有统计学意义（P<0.001）。出院时的药物数量与再入院风险增加相关（OR=1.07；95%CI=1.01至1.14）。与对照组相比，PC项目显著降低了出院后多药治疗的程度和患者的治疗复杂性。这凸显了实施旨在减少多药治疗和预防可能导致PAR的药物相关问题的PI时，患者选择和优先级策略的必要性。
