Medications Reconciled at Discharge Versus Admission Among Inpatients at a Children's Hospital.
Medications Reconciled at Discharge Versus Admission Among Inpatients at a Children's Hospital.
复制标题
DOI：
10.1542/hpeds.2021-006080
复制
发表时间：
2021-12-01
影响因子：
--
通讯作者：
Roth, Daniel E
中科院分区：
文献类型：
--
作者：
Emdin, Abby;Strzelecki, Marina;Seto, Winnie;Feinstein, James;Bogler, Orly;Cohen, Eyal;Roth, Daniel E
出院处方实践可能会导致药物过度使用和多重用药。我们的目的是估计三级儿科医院住院患者出院（与入院）时报告的药物数量和类型的变化。提取了 2016 年 1 月 1 日至 2017 年 12 月 31 日期间病童医院（加拿大多伦多）住院患者的电子药物调节数据（n = 22058）。对出院时（与入院时）药物数量的相对变化以及特定类型和药物亚类的相对风险（RR）进行总体估计并按以下因素进行分层：性别、年龄组、复杂慢性病（CCC）的诊断、手术或重症监护病房（PICU）入院。初步分析中排除了微量营养素补充剂、非阿片类镇痛药、泻药、泻药和抗生素。出院时的药物计数是入院时的 1.27 倍 [95% CI：1.25–1.29]。出院时的药物变化（与入院相比）因年龄较小、无 CCC、手术、入住 PICU 以及从外科手术出院而增加。出院时最常见的药物亚类是阿片类药物（占出院人数的 22%）、质子泵抑制剂（18%）、支气管扩张剂（10%）、止吐药（9%）和皮质类固醇（9%）。与非手术患者 (RR: 2.38 [95% CI: 2.22–2.56]) 相比，术后患者出院时（与入院相比）阿片类药物处方的相对风险较高 (RR: 13.3 [95% CI:11.5–15.3])。儿科住院患者出院时服用的药物比入院时服用的药物还要多，而且这些药物通常是酌情服用的药物，而不是必需的药物。术后患者阿片类药物处方的高频率是教育和临床决策支持干预的优先目标。本研究调查了儿童医院住院患者入院时列出的药物和出院时家庭药物的差异。
Discharge prescription practices may contribute to medication overuse and polypharmacy. We aimed to estimate changes in the number and types of medications reported at inpatient discharge (versus admission) at a tertiary care pediatric hospital. Electronic medication reconciliation data were extracted for inpatient admissions at the Hospital for Sick Children (Toronto, Canada) from January 1st, 2016 to December 31st, 2017 (n=22058). Relative changes in the number of medications and relative risks (RR) of specific types and subclasses of medications at discharge (versus admission) were estimated overall and stratified by: sex, age group, diagnosis of a complex chronic condition (CCC), surgery, or intensive care unit (PICU) admission. Micronutrient supplements, non-opioid analgesics, cathartics, laxatives, and antibiotics were excluded in primary analyses. Medication counts at discharge were 1.27-fold [95% CI: 1.25–1.29] greater than admission. The change in medications at discharge (versus admission) was increased by younger age, absence of a CCC, surgery, PICU admission, and discharge from a surgical service. The most common drug subclasses at discharge were opioids (22% of discharges), proton pump inhibitors (18%), bronchodilators (10%), antiemetics (9%), and corticosteroids (9%). Post-surgical patients had higher relative risks of opioid prescriptions at discharge (versus admission) (RR: 13.3 [95% CI:11.5–15.3]) compared to non-surgical patients (RR: 2.38 [95% CI: 2.22–2.56]). Pediatric inpatients were discharged home with more medications than admission, frequently with drugs that may be discretionary rather than essential. The high frequency of opioid prescriptions in post-surgical patients is a priority target for educational and clinical decision support interventions. This study examines differences in medications listed at admission and home medications at discharge in inpatients at a children’s hospital.