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

IF 5.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES BMJ Quality & Safety Pub Date : 2024-12-13 DOI:10.1136/bmjqs-2024-017297
Yan Xiao, Yea-Jen Hsu, Susan M Hannum, Ephrem Abebe, Melinda E Kantsiper, Ivonne Marie Pena, Andrea M Wessell, Sydney M Dy, Eric E Howell, Ayse P Gurses
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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.

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评估老年人护理过渡期间药物管理的患者工作系统因素:一项观察研究。
目的旨在开发和评估老年人从医院到家庭的护理过渡期间,可用于改善药物管理的患者工作系统因素的测量方法:在一项多地点前瞻性观察研究中,对 2018 年 8 月至 2019 年 7 月期间从美国两家医院医疗单位出院回家的老年人(≥65 岁)进行了测量:使用六项能力指标、四项任务指标和三项药物管理实践指标评估住院期间患者管理药物的工作系统因素。主要结果是出院后一周左右在参与者家中评估(1)家中服用的药物与病历中列出的药物之间的差异,以及(2)患者对新药物治疗方案的体验。结果:在招募的 376 名参与者中,有 274 人完成了家庭评估(72.8%)。在能力指标中,大多数老年人(80.6%)在过渡期间在没有护理人员的情况下管理药物,41.2%的老年人表示在管理药物方面自我效能较低,18.3%的老年人无法完成基本的药物管理任务。在任务指标中,半数以上(57.7%)的老年人有 10 种以上的出院用药,大多数(94.7%)的老年人有用药方案变更。出院用药超过 10 种、更换用药方案超过 2 次以及用药管理自我效能低,都会增加感到不知所措的风险(OR 2.63,95% CI 1.08 至 6.38;OR 3.16,95% CI 1.29 至 7.74;OR 2.56,95% CI 1.25 至 5.26)。交通独立性低、没有家庭护理人员、用药技能低和出院用药超过 10 种会增加用药差异的风险(发生率比分别为 1.39(95% CI 1.01 至 1.91)、1.73(95% CI 1.13 至 2.66)、1.99(95% CI 1.37 至 2.89)和 1.91(95% CI 1.24 至 2.93):患者工作系统因素可在出院前进行评估,其指标表明,在老年人从医院向家庭过渡的护理过程中,患者体验不佳和用药不一致的风险会增加。
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来源期刊
BMJ Quality & Safety
BMJ Quality & Safety HEALTH CARE SCIENCES & SERVICES-
CiteScore
9.80
自引率
7.40%
发文量
104
审稿时长
4-8 weeks
期刊介绍: BMJ Quality & Safety (previously Quality & Safety in Health Care) is an international peer review publication providing research, opinions, debates and reviews for academics, clinicians and healthcare managers focused on the quality and safety of health care and the science of improvement. The journal receives approximately 1000 manuscripts a year and has an acceptance rate for original research of 12%. Time from submission to first decision averages 22 days and accepted articles are typically published online within 20 days. Its current impact factor is 3.281.
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