Effectiveness of an Integrated Ambulatory Care Program in Health Care and Medication Use in Patients With Multimorbidity and Polypharmacy.

IF 1.2 4区医学 Q4 HEALTH CARE SCIENCES & SERVICES

Quality Management in Health Care Pub Date : 2024-01-01 Epub Date: 2023-09-20 DOI:10.1097/QMH.0000000000000434

Yu-Tai Lo, Mei-Hua Chen, Pin-Hao Chen, Feng-Hwa Lu, Chia-Ming Chang, Yi-Ching Yang

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引用次数: 0

Abstract

Background and objectives: Multimorbidity increases risks, such as polypharmacy, inappropriate prescription, and functional decline. It also increases medical care utilization by older adults, placing a burden on health care systems. This study evaluated the effectiveness of an integrated ambulatory care program for health care and medication use in patients with multimorbidity and polypharmacy.

Methods: We conducted a retrospective clinical review of adults with multimorbidity and polypharmacy who attended an integrated ambulatory care program at a 1193-bed university hospital between July 1 and September 30, 2019. This program involves multidisciplinary teamwork, comprehensive assessments, medication reviews, and case management. Outcomes, including the frequency of outpatient visits, emergency department visits, hospitalizations, chronic prescription medications, potentially inappropriate medications (PIMs), health care costs, and total medical expenditure, were compared before and after the program.

Results: The mean age of participants (n = 134) at baseline was 74.22 ± 9.75 years. The mean number of chronic diagnoses was 9.45 ± 3.38. Participants included 72 (53.7%) women. At the 1-year follow-up, participants showed a significant decrease in the annual frequency of outpatient visits (19.78 ± 9.98 to 13.90 ± 10.22, P < .001), emergency department visits (1.04 ± 1.70 to 0.73 ± 1.40, P = .029), and chronic disease medications (10.71 ± 3.96 to 9.57 ± 3.67, P < .001) across all age groups. There was also a reduction in the annual number of PIMs (from 1.31 ± 1.01 to 1.12 ± 0.93, P = .002) among patients aged 65 years. However, no effects were observed on annual hospitalization, duration of hospital stay, or total health care expenditure, possibly due to the high disease-related treatment cost for certain participants.

Conclusions: Expanding integrated ambulatory care programs in Taiwan may help patients with multimorbidity reduce their use of outpatient and emergency services, chronic prescriptions, and PIMs.

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综合门诊护理计划在多发病和多药治疗患者的医疗保健和药物使用中的有效性。

背景和目的：多发病会增加风险，如多药治疗、处方不当和功能下降。它还增加了老年人对医疗保健的利用，给医疗保健系统带来了负担。这项研究评估了综合门诊护理计划对多发病和多药物患者的医疗保健和药物使用的有效性。方法：我们对2019年7月1日至9月30日期间在一家拥有1193张床位的大学医院参加综合门诊护理项目的患有多发病和多药治疗的成年人进行了回顾性临床审查。该项目涉及多学科团队合作、综合评估、药物审查和病例管理。比较项目前后的结果，包括门诊就诊频率、急诊就诊频率、住院频率、慢性处方药、潜在不适当药物（PIM）、医疗保健费用和医疗总支出。结果：参与者（n=134）在基线时的平均年龄为74.22±9.75岁。慢性病的平均诊断数为9.45±3.38。参与者包括72名（53.7%）女性。在一年的随访中，参与者显示，所有年龄组的年门诊就诊次数（19.78±9.98至13.90±10.22，P＜0.001）、急诊就诊次数（1.04±1.70至0.73±1.40，P＝0.29）和慢性病药物治疗次数（10.71±3.96至9.57±3.67，P＜.001）均显著减少。65岁患者的PIM年数量也有所减少（从1.31±1.01降至1.12±0.93，P=0.002）。然而，没有观察到对年度住院治疗、住院时间或医疗保健总支出的影响，这可能是由于某些参与者的疾病相关治疗费用较高。结论：在台湾扩大综合门诊护理计划可能有助于多发性疾病患者减少门急诊、慢性处方和PIM的使用。

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

Quality Management in Health Care HEALTH CARE SCIENCES & SERVICES-

CiteScore

1.90

自引率

8.30%

发文量

108

期刊介绍： Quality Management in Health Care (QMHC) is a peer-reviewed journal that provides a forum for our readers to explore the theoretical, technical, and strategic elements of health care quality management. The journal''s primary focus is on organizational structure and processes as these affect the quality of care and patient outcomes. In particular, it: -Builds knowledge about the application of statistical tools, control charts, benchmarking, and other devices used in the ongoing monitoring and evaluation of care and of patient outcomes; -Encourages research in and evaluation of the results of various organizational strategies designed to bring about quantifiable improvements in patient outcomes; -Fosters the application of quality management science to patient care processes and clinical decision-making; -Fosters cooperation and communication among health care providers, payers and regulators in their efforts to improve the quality of patient outcomes; -Explores links among the various clinical, technical, administrative, and managerial disciplines involved in patient care, as well as the role and responsibilities of organizational governance in ongoing quality management.