Impact of a Pharmaceutical Care Program at Discharge on Patients at High Risk of Readmission According to the Hospital Score.

IF 1.1 Q4 PHARMACOLOGY & PHARMACY
Journal of Pharmacy Technology Pub Date : 2021-12-01 Epub Date: 2021-09-22 DOI:10.1177/87551225211047607
María Luisa Ibarra Mira, Jose Manuel Caro-Teller, Pedro Pablo Rodríguez Quesada, Carmen Garcia-Muñoz, Almudena Añino Alba, Jose Miguel Ferrari Piquero
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引用次数: 1

Abstract

Background: A significant percentage of hospital readmissions within 30 days of discharge are a result of avoidable drug-related problems. Stratifying patients according to readmission risk is key to pharmaceutical intervention (PI) design strategies to improve treatment outcomes. Objective: To assess whether a pharmaceutical care (PC) program at discharge in polymedicated patients at high potentially avoidable readmission (PAR) risk, according to the HOSPITAL score, improves 30-day readmission rate (30-dRR). Methods: This prospective controlled, quasi-experimental, 11-month study included 163 chronic polymedicated patients (>5 medications) at high PAR risk according to the HOSPITAL score. We calculated the 30-dRR and number of medication variations and Medication Regimen Complexity Index-E (MRCI-E) after PI. Results were compared with a retrospective cohort of chronic patients at high PAR risk. Results: The 30-dRR was 18.4% in the intervention group and 25.6% in the control group (odds ratio [OR] = 0.66; 95% CI = 0.38 to 1.14). Total medication reduction (-1.28; 95% CI = -1.88 to -0.68), number of high-risk medications in chronic patients (-0.58; 95% CI = -0.9 to -0.26), and MRCI-E (-6.42; 95% CI = -8.07 to -4.76) were statistically significant (P < .001). The number of medications at discharge was associated with an increased readmission risk (OR = 1.07; 95% CI = 1.01 to 1.14). Conclusions: The degree of polypharmacy and patients' treatment complexity after hospital discharge significantly reduced as a result of the PC program compared with the control group. This highlights the need for patient selection and prioritization strategies for implementing PIs focused on reducing polypharmacy and preventing drug-related problems that may cause PAR.

根据医院评分,出院时药物护理计划对再入院高风险患者的影响。
背景:出院后30天内再入院的患者中有很大比例是由于可避免的药物相关问题。根据再入院风险对患者进行分层是改善治疗结果的药物干预(PI)设计策略的关键。目的:评估根据HOSPITAL评分,在多药患者出院时进行药学护理(PC)计划是否能提高30天再入院率(30-dRR)。方法:这项前瞻性对照、准实验、为期11个月的研究纳入了163例慢性多药患者(>5种药物),根据HOSPITAL评分存在高PAR风险。计算PI后30-dRR、用药变化数和用药方案复杂性指数- e (MRCI-E)。结果与PAR高风险慢性患者的回顾性队列进行比较。结果:干预组30-dRR为18.4%,对照组为25.6%(优势比[OR] = 0.66;95% CI = 0.38 ~ 1.14)。总用药减少量(-1.28;95% CI = -1.88 ~ -0.68),慢性患者高危药物数量(-0.58;95% CI = -0.9 ~ -0.26), MRCI-E (-6.42;95% CI = -8.07 ~ -4.76),差异有统计学意义(P < 0.001)。出院时使用的药物数量与再入院风险增加相关(OR = 1.07;95% CI = 1.01 ~ 1.14)。结论:与对照组相比,PC方案显著降低了患者出院后的多药程度和治疗复杂性。这突出了实施pi的患者选择和优先战略的必要性,重点是减少多药和预防可能导致PAR的药物相关问题。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Pharmacy Technology
Journal of Pharmacy Technology PHARMACOLOGY & PHARMACY-
CiteScore
1.50
自引率
0.00%
发文量
49
期刊介绍: For both pharmacists and technicians, jPT provides valuable information for those interested in the entire body of pharmacy practice. jPT covers new drugs, products, and equipment; therapeutic trends; organizational, legal, and educational activities; drug distribution and administration; and includes continuing education articles.
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