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首页> 外文期刊>The American journal of geriatric pharmacotherapy >Inpatient medication reconciliation at admission and discharge: A retrospective cohort study of age and other risk factors for medication discrepancies.
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Inpatient medication reconciliation at admission and discharge: A retrospective cohort study of age and other risk factors for medication discrepancies.

机译：入院和出院时住院药物的核对：年龄和其他药物差异危险因素的回顾性队列研究。

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BACKGROUND: Medication discrepancies are unintended differences between medication regimens (ie, between a patient's home regimen and medications prescribed on admission to the hospital). OBJECTIVE: The goal of this study was to describe the incidence, drug classes, and probable importance of hospital admission medication discrepancies and discharge regimen differences, and to determine whether factors such as age and specific hospital services were associated with greater frequency of medication discrepancies and differences. METHODS: This was a retrospective cohort study of a random sample of adult patients admitted to the general medicine, cardiology, or general surgery services of a tertiary care academic teaching hospital between July 1, 2006, and August 31, 2006. A chart review was performed to collect the following information: patient demographic characteristics, comorbid conditions, number of preadmission medications, discrepant medications identified by the hospital's reconciliation process, reasons for the discrepancies, and discharge medications that differed from the home regimen. Potentially high-risk discrepancies and differences were identified by determining if the medications were included on either the Institute for Safe Medication Practices high-alert list or the North Carolina Narrow Therapeutic Index list. Univariate and multivariate logistic regression analyses were used to identify factors associated with medication discrepancies and differences. RESULTS: Of the 205 patients (mean age, 59.9 years; 116 men, 89 women; 60% white) included in the study, 27 did not have any medications recorded on admission. Of the 178 patients who did have medications listed, 41 had >or=1 discrepancy identified by the reconciliation process on admission (23%; 95% CI, 17-29); 19% (95% CI, 11-31) of these medications were considered to be potentially high risk. In the multivariate logistic regression model, age (odds ratio [OR] per 5-year increase = 1.16; 95% CI, 1.01-1.33; P = 0.035), presence of high-risk medications on admission (OR = 76.68; 95% CI, 9.13-643.76; P < 0.001), and general surgery service (OR = 3.31; 95% CI, 1.40-7.87; P < 0.007) were associated with a higher proportion of patients with discrepancies on admission. At discharge, 196 patients (96% [95% CI, 93<98]) had >or=1 medication change from their home regimen, with 1102 total differences for 205 patients. Less than half (44% [95% CI, 37-51]) of these patients were explicitly alerted at discharge to new medications or dose changes; 12% (95% CI, 7-18) were given written instructions to stop taking discontinued home medications. Cardiovascular drugs were the most frequent class involved at both admission (31%) and discharge (27%) in medication discrepancies or differences. CONCLUSIONS: Medication discrepancies on admission and medication differences at discharge were prevalent for adult patients admitted to the general medicine, cardiology, and general surgery services in this academic teaching hospital. Medication reconciliation processes have a high potential to identify clinically important discrepancies for all patients.
机译：背景：药物差异是药物治疗方案之间的意外差异（即，患者的家庭治疗方案与入院时开出的药物之间的差异）。目的：本研究的目的是描述入院药物差异和出院方案差异的发生率，药物种类和重要性，并确定年龄和特定医院服务等因素是否与药物差异发生的频率更高相关，差异。方法：这是一项对2006年7月1日至2006年8月31日之间接受三级学术教学医院的普通医学，心脏病学或普通外科服务的成年患者进行随机抽样的回顾性队列研究。收集以下信息：患者的人口统计学特征，合并症，入院前用药的数量，医院和解过程中发现的差异用药，差异的原因以及出院药物与家庭方案不同。通过确定药物是否被列入安全药物实践协会高警报列表或北卡罗来纳州狭窄治疗指数列表中，可以识别出潜在的高风险差异和差异。使用单因素和多因素逻辑回归分析来确定与药物差异和差异相关的因素。结果：纳入研究的205例患者（平均年龄59.9岁;男性116例，女性89例;白人占60％）中，有27例入院时未记录任何药物。在178例确实列出了用药的患者中，有41例在入院时通过和解过程发现差异≥1（23％; 95％CI，17-29）;这些药物中有19％（95％CI，11-31）被认为是潜在的高风险。在多元logistic回归模型中，年龄（每5年增加的比值比[OR] = 1.16; 95％CI，1.01-1.33; P = 0.035），入院时存在高风险药物（OR = 76.68; 95％ CI为9.13-643.76; P <0.001）和普通外科手术服务（OR = 3.31; 95％CI为1.40-7.87; P <0.007）与住院率差异较高的患者相关。出院时，有196例患者（96％[95％CI，93 <98]）的家庭用药变更大于或等于1，205例患者的总差异为1102。这些患者中只有不到一半（44％[95％CI，37-51]）在出院时被告知要使用新药或改变剂量;给了12％（95％CI，7-18）的书面指示，以停止服用已停药的家庭药物。在药物差异或差异方面，心血管药物是入院（31％）和出院（27％）时最常见的类别。结论：在这所学术教学医院接受普通医学，心脏病学和普通外科服务的成年患者中，入院时的药物差异和出院时的药物差异普遍存在。药物和解过程具有很高的潜力，可为所有患者确定临床上重要的差异。

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