Potentially Inappropriate Prescribing in Hospitalized Older Adult High-Cost Health Care Users: A Pilot Study.

IF 0.8 Q4 PHARMACOLOGY & PHARMACY
Monica Sanh, Anne Holbrook, Peter D M Macdonald, Justin Lee
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引用次数: 2

Abstract

Background: High-cost health care users use disproportionate amounts of health care resources relative to the typical patient. It is unclear to what extent poor-quality prescribing, including potentially inappropriate prescribing (PIP), may be contributing to their adverse outcomes and health utilization costs.

Objectives: To evaluate the prevalence of PIP and to explore its impact in older adult high-cost health care users.

Methods: The charts of older adult high-cost health care users admitted to 2 academic hospitals in Ontario, Canada, in fiscal year 2015/16 were reviewed. Eligible patients were at least 66 years old with at least 5 emergency department visits and 3 hospital admissions in the previous year. A total of 243 patients met these criteria, of whom 100 were randomly selected for review. Cases of PIP were identified using explicit prescribing quality indicators, including the STOPP/START criteria. Types of PIP included potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs). Log-linear regression was used to characterize the relationship between PIP and future health care utilization. Medications were reconciled to determine the proportion of PIP addressed by the time of discharge.

Results: Eighty-nine of the 100 patients had at least 1 instance of PIP. In total, 276 PIMs and 54 PPOs were identified. Of the 271 instances of PIP identified on admission, only 38 (14%) were resolved by the time of hospital discharge. Each additional PPO was associated with a 1.43-fold increase in the rate of future emergency department visits (p < 0.001).

Conclusions: The rate of PIP among older adult high-cost health care users was high. Despite frequent interactions with the health care system, many opportunities to improve the quality of prescribing for this vulnerable population were missed. Greater attention to medication optimization is needed.

住院的老年高费用医疗保健使用者可能不适当的处方:一项试点研究。
背景:与典型患者相比,高成本医疗保健使用者使用了不成比例的医疗保健资源。目前尚不清楚低质量的处方,包括潜在的不当处方(PIP),在多大程度上可能导致他们的不良后果和健康利用成本。目的:评估PIP的患病率,并探讨其对老年人高成本医疗服务使用者的影响。方法:回顾性分析2015/16财政年度加拿大安大略省2所专科医院老年人高费用医疗服务用药者病历。符合条件的患者年龄至少为66岁,前一年至少有5次急诊就诊和3次住院。共有243例患者符合这些标准,其中随机选择100例进行评价。使用明确的处方质量指标(包括STOPP/START标准)确定PIP病例。PIP的类型包括潜在的不适当药物(pim)和潜在的处方遗漏(PPOs)。使用对数线性回归来表征PIP与未来医疗保健利用之间的关系。对药物进行调和,以确定出院时解决PIP的比例。结果:100例患者中89例至少发生1例PIP。总共确定了276个pim和54个ppo。在入院时确定的271例PIP中,只有38例(14%)在出院时得到解决。每增加一次PPO,未来急诊科就诊率增加1.43倍(p < 0.001)。结论:老年人高费用医疗服务使用者的PIP发生率较高。尽管与卫生保健系统的互动频繁,但却错过了许多提高弱势群体处方质量的机会。需要更多地关注药物优化。
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来源期刊
CANADIAN JOURNAL OF HOSPITAL PHARMACY
CANADIAN JOURNAL OF HOSPITAL PHARMACY PHARMACOLOGY & PHARMACY-
CiteScore
1.10
自引率
0.00%
发文量
64
期刊介绍: The CJHP is an academic journal that focuses on how pharmacists in hospitals and other collaborative health care settings optimize safe and effective drug use for patients in Canada and throughout the world. The aim of the CJHP is to be a respected international publication serving as a major venue for dissemination of information related to patient-centred pharmacy practice in hospitals and other collaborative health care settings in Canada and throughout the world.
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