Division of Hospital Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA; Center for Quality Aging, Vanderbilt University Medical Center, Nashville, TN, USA; Section of Hospital Medicine, Division of General Internal Medicine & Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA; Geriatric Research Education and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, TN, USA.
Department of Medicine, University of Central Florida College of Medicine, Orlando, FL, USA.
J Am Med Dir Assoc. 2024 Jul;25(7):105017. doi: 10.1016/j.jamda.2024.105017. Epub 2024 May 13.
The epidemiology of medication discrepancies during transitions from post-acute care (PAC) to home is poorly described. We sought to describe the frequency and types of medication discrepancies among hospitalized older adults transitioning from PAC to home.
A nested cohort analysis.
Included participants enrolled in a patient-centered deprescribing trial, for patients (aged ≥50 years and taking at least 5 medications) transitioning from one of 22 PACs to home.
We assessed demographic and medication measures at the initial hospitalization. The primary outcome measure was medication discrepancies, with the PAC discharge list serving as reference for comparison to the participant's self-reported medication list at 7 days following PAC discharge. Discrepancies were categorized as additions, omissions, and dose discrepancies and were organized by common medication classes and risk of harm (eg, 2015 Beers Criteria). Ordinal logistic regression assessed for patient risk factors for PAC discharge discrepancy count.
A total of 184 participants had 7-day PAC discharge medication data. Participants were predominately female (67%) and Caucasian (83%) with a median of 16 prehospital medications [interquartile range (IQR) 11, 20]. At the 7-day follow-up, 98% of participants had at least 1 medication discrepancy, with a median number of 7 medication discrepancies (IQR 4, 10) per person, 4 (IQR 2, 6) of which were potentially inappropriate medications as defined by the Beers Criteria. Higher medication discrepancies at index hospital admission and receipt of caregiver assistance with medications were 2 key predictors of medication discrepancies in the week after PAC discharge to home.
Older patients transitioning home from a PAC facility are at high risk for medication discrepancies. This study underscores the need for interventions targeted at this overlooked transition period, especially as patients resume responsibility for managing their own medications after both a hospital and PAC stay.
从急性后期护理（PAC）到家庭过渡期间药物差异的流行病学描述很差。我们旨在描述从 PAC 过渡到家庭的住院老年人中药物差异的频率和类型。
嵌套队列分析。
包括参加以患者为中心的去药物试验的患者，这些患者（年龄≥50 岁，服用至少 5 种药物）从 22 个 PAC 中的一个过渡到家庭。
我们评估了初次住院时的人口统计学和药物措施。主要结局指标是药物差异，将 PAC 出院清单作为比较参与者 PAC 出院后 7 天内自我报告的药物清单的参考。差异分为添加、遗漏和剂量差异，并按常见药物类别和危害风险（例如，2015 年 Beers 标准）进行分类。有序逻辑回归评估 PAC 出院差异计数的患者危险因素。
共有 184 名参与者有 7 天 PAC 出院药物数据。参与者主要为女性（67%）和白种人（83%），中位数为 16 种术前药物[四分位间距（IQR）11，20]。在 7 天的随访中，98%的参与者至少有一种药物差异，中位数为每人 7 种药物差异（IQR 4，10），其中 4 种（IQR 2，6）是根据 Beers 标准定义的潜在不适当药物。指数住院入院时药物差异较高和接受护理人员药物帮助是 PAC 出院后一周内药物差异的 2 个关键预测因素。
从 PAC 机构过渡到家庭的老年患者发生药物差异的风险很高。这项研究强调需要针对这一被忽视的过渡时期进行干预，特别是因为患者在住院和 PAC 住院后恢复管理自己药物的责任。
