评估老年人护理过渡期间药物管理的患者工作系统因素：一项观察性研究。

Assessing patient work system factors for medication management during transition of care among older adults: an observational study.

作者信息

Xiao Yan, Hsu Yea-Jen, Hannum Susan M, Abebe Ephrem, Kantsiper Melinda E, Pena Ivonne Marie, Wessell Andrea M, Dy Sydney M, Howell Eric E, Gurses Ayse P

机构信息

College of Nursing and Health Innovation, The University of Texas at Arlington, Arlington, Texas, USA

Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.

出版信息

BMJ Qual Saf. 2024 Dec 13;34(1):8-17. doi: 10.1136/bmjqs-2024-017297.

DOI:10.1136/bmjqs-2024-017297

PMID:39179376

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11645227/

Abstract

OBJECTIVE

To develop and evaluate measures of patient work system factors in medication management that may be modifiable for improvement during the care transition from hospital to home among older adults.

DESIGN, SETTINGS AND PARTICIPANTS: Measures were developed and evaluated in a multisite prospective observational study of older adults (≥65 years) discharged home from medical units of two US hospitals from August 2018 to July 2019.

MAIN MEASURES

Patient work system factors for managing medications were assessed during hospital stays using six capacity indicators, four task indicators and three medication management practice indicators. Main outcomes were assessed at participants' homes approximately a week after discharge for (1) Medication discrepancies between the medications taken at home and those listed in the medical record, and (2) Patient experiences with new medication regimens.

RESULTS

274 of the 376 recruited participants completed home assessment (72.8%). Among capacity indicators, most older adults (80.6%) managed medications during transition without a caregiver, 41.2% expressed low self-efficacy in managing medications and 18.3% were not able to complete basic medication administration tasks. Among task indicators, more than half (57.7%) had more than 10 discharge medications and most (94.7%) had medication regimen changes. Having more than 10 discharge medications, more than two medication regimen changes and low self-efficacy in medication management increased the risk of feeling overwhelmed (OR 2.63, 95% CI 1.08 to 6.38, OR 3.16, 95% CI 1.29 to 7.74 and OR 2.56, 95% CI 1.25 to 5.26, respectively). Low transportation independence, not having a home caregiver, low medication administration skills and more than 10 discharge medications increased the risk of medication discrepancies (incidence rate ratio 1.39, 95% CI 1.01 to 1.91, incidence rate ratio 1.73, 95% CI 1.13 to 2.66, incidence rate ratio 1.99, 95% CI 1.37 to 2.89 and incidence rate ratio 1.91, 95% CI 1.24 to 2.93, respectively).

CONCLUSIONS

Patient work system factors could be assessed before discharge with indicators for increased risk of poor patient experience and medication discrepancies during older adults' care transition from hospital to home.

摘要

目的

制定并评估药物管理中患者工作系统因素的衡量指标，这些因素在老年人从医院到家庭的护理过渡期间可能是可修改以促进改善的。

设计、设置和参与者：在一项多地点前瞻性观察性研究中制定并评估衡量指标，该研究对象为2018年8月至2019年7月从美国两家医院医疗科室出院回家的老年人（≥65岁）。

主要衡量指标

在住院期间，使用六个能力指标、四个任务指标和三个药物管理实践指标评估管理药物的患者工作系统因素。主要结局在参与者出院约一周后在其家中进行评估，包括（1）在家服用的药物与病历中列出的药物之间的用药差异，以及（2）患者对新用药方案的体验。

结果

376名招募的参与者中有274名完成了家庭评估（72.8%）。在能力指标方面，大多数老年人（80.6%）在过渡期间无需照料者即可管理药物，41.2%的老年人表示在管理药物方面自我效能感较低，18.3%的老年人无法完成基本的药物给药任务。在任务指标方面，超过一半（57.7%）的患者有超过10种出院带药，大多数（94.7%）患者的用药方案有变化。出院带药超过10种、用药方案变化超过两种以及药物管理自我效能感低会增加感到不堪重负的风险（比值比分别为2.63，95%置信区间1.08至6.38；3.16，95%置信区间1.29至7.74；2.56，95%置信区间1.25至5.26）。交通独立性低、没有家庭照料者、药物给药技能低以及出院带药超过10种会增加用药差异的风险（发病率比分别为1.39，95%置信区间1.01至1.91；1.73，95%置信区间1.13至2.66；1.99，95%置信区间1.37至2.89；1.91，95%置信区间1.24至2.93）。