综合性门诊护理计划对多病共存和多重用药患者的医疗保健和药物使用的效果。

Effectiveness of an Integrated Ambulatory Care Program in Health Care and Medication Use in Patients With Multimorbidity and Polypharmacy.

机构信息

Departments of Geriatrics and Gerontology (Drs Lo, Lu, Chang, and Yang and Ms M.-H. Chen) and Pharmacy (Mr P.-H. Chen), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan (Drs Lu and Yang); and Department of Medicine & Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan (Dr Chang).

出版信息

Qual Manag Health Care. 2024;33(1):18-28. doi: 10.1097/QMH.0000000000000434. Epub 2023 Sep 20.

DOI:10.1097/QMH.0000000000000434

PMID:37752634

Abstract

BACKGROUND AND OBJECTIVES

Multimorbidity increases risks, such as polypharmacy, inappropriate prescription, and functional decline. It also increases medical care utilization by older adults, placing a burden on health care systems. This study evaluated the effectiveness of an integrated ambulatory care program for health care and medication use in patients with multimorbidity and polypharmacy.

METHODS

We conducted a retrospective clinical review of adults with multimorbidity and polypharmacy who attended an integrated ambulatory care program at a 1193-bed university hospital between July 1 and September 30, 2019. This program involves multidisciplinary teamwork, comprehensive assessments, medication reviews, and case management. Outcomes, including the frequency of outpatient visits, emergency department visits, hospitalizations, chronic prescription medications, potentially inappropriate medications (PIMs), health care costs, and total medical expenditure, were compared before and after the program.

RESULTS

The mean age of participants (n = 134) at baseline was 74.22 ± 9.75 years. The mean number of chronic diagnoses was 9.45 ± 3.38. Participants included 72 (53.7%) women. At the 1-year follow-up, participants showed a significant decrease in the annual frequency of outpatient visits (19.78 ± 9.98 to 13.90 ± 10.22, P < .001), emergency department visits (1.04 ± 1.70 to 0.73 ± 1.40, P = .029), and chronic disease medications (10.71 ± 3.96 to 9.57 ± 3.67, P < .001) across all age groups. There was also a reduction in the annual number of PIMs (from 1.31 ± 1.01 to 1.12 ± 0.93, P = .002) among patients aged 65 years. However, no effects were observed on annual hospitalization, duration of hospital stay, or total health care expenditure, possibly due to the high disease-related treatment cost for certain participants.

CONCLUSIONS

Expanding integrated ambulatory care programs in Taiwan may help patients with multimorbidity reduce their use of outpatient and emergency services, chronic prescriptions, and PIMs.

摘要

背景与目的

多种疾病会增加风险，如多种药物治疗、不适当的处方和功能下降。它还会增加老年患者的医疗保健利用，给医疗保健系统带来负担。本研究评估了针对患有多种疾病和多种药物治疗的患者的综合门诊护理计划在医疗保健和药物使用方面的有效性。

方法

我们对 2019 年 7 月 1 日至 9 月 30 日期间在一家拥有 1193 张床位的大学医院参加综合门诊护理计划的患有多种疾病和多种药物治疗的成年人进行了回顾性临床审查。该计划涉及多学科团队合作、全面评估、药物审查和病例管理。在该计划前后，比较了门诊就诊次数、急诊就诊次数、住院次数、慢性病处方药物、潜在不适当药物（PIMs）、医疗保健费用和总医疗支出等结果。

结果

参与者（n=134）的平均年龄为 74.22±9.75 岁。慢性病的平均诊断数为 9.45±3.38。参与者包括 72 名（53.7%）女性。在 1 年的随访中，参与者显示门诊就诊次数（19.78±9.98 次至 13.90±10.22 次，P<.001）、急诊就诊次数（1.04±1.70 次至 0.73±1.40 次，P=.029）和慢性病药物使用次数（10.71±3.96 次至 9.57±3.67 次，P<.001）均显著减少，所有年龄段的 PIMs 数量也有所减少（从 1.31±1.01 次降至 1.12±0.93 次，P=.002）。然而，由于某些参与者的疾病相关治疗费用较高，住院人数、住院时间和总医疗保健支出方面未观察到效果。