Department of Family Medicine, Taipei City Hospital, Yangming Branch, No. 105, Yusheng Street, Shilin District, Taipei City 111, Taiwan.
Institute of Public Health, National Yang Ming Chiao Tung University, No. 155, Sec.2, Linong Street, Taipei City 112, Taiwan.
Int J Qual Health Care. 2022 Jul 9;34(3). doi: 10.1093/intqhc/mzac055.
Inappropriate management of medications is a major threat to homebound patients with chronic conditions. Despite many efforts in improving medication reconciliation in ambulatory and inpatient settings, little research has focused on home care settings. In 2016, Taiwan initiated the Integrated Home Health Care programme, which was intended to reduce potentially inappropriate medication management and risks of uncontrolled polypharmacy through the integration of different medication sources for chronic conditions among homebound patients. This study investigated factors associated with having home care physicians as an integrated source of medications for chronic conditions among homebound patients.
This retrospective cohort study enrolled 3142 community-dwelling homebound patients from Taipei City Hospital. Homebound patients' adherence to using home care physicians as an integrated source of chronic condition medications was defined as having all prescriptions for their chronic conditions prescribed by a single home care physician for at least 6 months. Both patient and home care physician characteristics were analysed. Multivariable logistic regression was applied.
Of the 3142 patients with chronic conditions, 1002 (31.9%) had consistently obtained all medications for their chronic illnesses from their home care physicians for 6 months and 2140 (68.1%) had not. The most common chronic diseases among homebound patients were hypertension, diabetes mellitus, dementia, cerebrovascular disease and constipation. Oldest-old patients with poor functional status, fewer daily medications, no co-payment exemption and no recent inpatient experience were more likely to adhere to this medication integration system. In addition, patients whose outpatient physicians were also their home care physicians were more likely to adhere to the system.
The finding suggests that building trust and enhancing communication among homebound patients, caregivers and home care physicians are critical. Patient and provider variations highlight the need for further improvement and policy modification for medication reconciliation and management in home care settings. The improvement in medication management and care integration in home care settings may reduce misuse and polypharmacy and improve homebound patients' safety.
药物管理不当是慢性病居家患者的主要威胁。尽管在改善门诊和住院环境中的药物重整方面做出了许多努力，但很少有研究关注家庭护理环境。2016 年，台湾启动了综合家庭健康护理计划，旨在通过整合慢性病患者的不同药物来源，减少潜在的不适当药物管理和未经控制的多种药物使用的风险。本研究调查了与居家患者的家庭保健医生作为慢性病综合药物来源相关的因素。
本回顾性队列研究纳入了来自台北市立医院的 3142 名社区居家的居家患者。居家患者是否遵医嘱使用家庭保健医生作为慢性病药物的综合来源，定义为至少 6 个月内所有慢性病处方均由单一家庭保健医生开具。分析了患者和家庭保健医生的特征。采用多变量逻辑回归分析。
在 3142 名患有慢性病的患者中，有 1002 名（31.9%）患者连续 6 个月从家庭保健医生处获得所有慢性病药物，2140 名（68.1%）患者未获得。居家患者最常见的慢性病包括高血压、糖尿病、痴呆、脑血管病和便秘。功能状态较差、每日用药较少、无共同支付豁免且近期无住院经历的最年长老年患者更有可能遵循这种药物整合系统。此外，其门诊医生也是家庭保健医生的患者更有可能遵循该系统。
研究结果表明，建立居家患者、护理人员和家庭保健医生之间的信任和加强沟通至关重要。患者和提供者的差异突出表明需要进一步改进和修改家庭护理环境中的药物重整和管理政策。家庭护理环境中药物管理和护理整合的改善可能减少药物滥用和多种药物使用，并提高居家患者的安全性。
