Thomas Roger E, Azzopardi Robert, Asad Mohammad, Tran Dactin
Faculty of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada.
Oracle Canada, Mississauga, ON L5R 4H1, Canada.
Geriatrics (Basel). 2023 Oct 9;8(5):100. doi: 10.3390/geriatrics8050100.
The goals of this retrospective cohort study of 129,443 persons admitted to Calgary acute care hospitals from 2013 to 2021 were to ascertain correlations of "potentially inappropriate medications" (PIMs), "potential prescribing omissions" (PPOs), and other risk factors with readmissions and mortality. : Processing and analysis codes were built in Oracle Database 19c (PL/SQL), R, and Excel. The percentage of patients dying during their hospital stay rose from 3.03% during the first admission to 7.2% during the sixth admission. The percentage of patients dying within 6 months of discharge rose from 9.4% after the first admission to 24.9% after the sixth admission. Odds ratios were adjusted for age, gender, and comorbidities, and for readmission, they were the post-admission number of medications (1.16; 1.12-1.12), STOPP PIMs (1.16; 1.15-1.16), AGS Beers PIMs (1.11; 1.11-1.11), and START omissions not corrected with a prescription (1.39; 1.35-1.42). The odds ratios for readmissions for the second to thirty-ninth admission were consistently higher if START PPOs were not corrected for the second (1.41; 1.36-1.46), third (1.41;1.35-1.48), fourth (1.35; 1.28-1.44), fifth (1.38; 1.28-1.49), sixth (1.47; 1.34-1.62), and seventh admission to thirty-ninth admission (1.23; 1.14-1.34). The odds ratios for mortality were post-admission number of medications (1.04; 1.04-1.05), STOPP PIMs (0.99; 0.96-1.00), AGS Beers PIMs (1.08; 1.07-1.08), and START omissions not corrected with a prescription (1.56; 1.50-1.63). START omissions for all admissions corrected with a prescription by a hospital physician correlated with a dramatic reduction in mortality (0.51; 0.49-0.53) within six months of discharge. This was also true for the second (0.52; 0.50-0.55), fourth (0.56; 0.52-0.61), fifth (0.63; 0.57-0.68), sixth (0.68; 0.61-0.76), and seventh admission to thirty-ninth admission (0.71; 0.65-0.78). "Potential prescribing omissions" (PPOs) consisted mostly of needed cardiac medications. These omissions occurred before the first admission of this cohort, and many persisted through their readmissions and discharges. Therefore, these omissions should be corrected in the community before admission by family physicians, in the hospital by hospital physicians, and if they continue after discharge by teams of family physicians, pharmacists, and nurses. These community teams should also meet with patients and focus on patients' understanding of their illnesses, medications, PPOs, and ability for self-care.
这项回顾性队列研究对2013年至2021年期间入住卡尔加里急症护理医院的129443人进行，其目的是确定“潜在不适当用药”（PIMs）、“潜在处方遗漏”（PPOs）及其他风险因素与再入院和死亡率之间的相关性。处理和分析代码是在Oracle数据库19c（PL/SQL）、R和Excel中构建的。住院期间死亡患者的比例从首次入院时的3.03%升至第六次入院时的7.2%。出院后6个月内死亡患者的比例从首次入院后的9.4%升至第六次入院后的24.9%。对年龄、性别和合并症进行了比值比调整，对于再入院情况，调整后的比值比涉及入院后用药数量（1.16；1.12 - 1.12）、STOPP PIMs（1.16；1.15 - 1.16）、AGS Beers PIMs（1.11；1.11 - 1.11）以及未通过处方纠正的START遗漏（1.39；1.35 - 1.42）。如果第二次（1.41；1.36 - 1.46）、第三次（1.41；1.35 - 1.48）、第四次（1.35；1.28 - 1.44）、第五次（1.38；1.28 - 1.49）、第六次（1.47；1.34 - 1.62）以及第七次至第三十九次入院时未纠正START PPOs，那么第二次至第三十九次入院再入院的比值比始终较高（1.23；1.14 - 1.34）。死亡率的比值比涉及入院后用药数量（1.04；1.04 - 1.05）、STOPP PIMs（0.99；0.96 - 1.00）、AGS Beers PIMs（1.08；1.07 - 1.08）以及未通过处方纠正的START遗漏（1.56；1.50 - 1.63）。医院医生通过处方纠正所有入院时的START遗漏与出院后六个月内死亡率大幅降低相关（0.51；0.49 - 0.53）。第二次（0.52；0.50 - 0.55）、第四次（0.56；0.52 - 0.61）、第五次（0.63；0.57 - 0.68）、第六次（0.68；0.61 - 0.76）以及第七次至第三十九次入院时也是如此（0.71；0.65 - 0.78）。“潜在处方遗漏”（PPOs）主要包括所需的心脏药物。这些遗漏发生在该队列首次入院之前，并且在他们的再入院和出院过程中许多一直存在。因此，这些遗漏应由家庭医生在社区入院前纠正，由医院医生在医院内纠正，如果出院后仍存在，则由家庭医生、药剂师和护士团队纠正。这些社区团队还应与患者会面，并关注患者对自身疾病、药物、PPOs以及自我护理能力的理解。
