Does home based medication review keep older people out of hospital? The HOMER randomised controlled trial
Does home based medication review keep older people out of hospital? The HOMER randomised controlled trial
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DOI：
10.1136/bmj.38338.674583.ae
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发表时间：
2005-02-05
影响因子：
105.7
通讯作者：
Hand, C
中科院分区：
文献类型：
--
作者：
Holland, R;Lenaghan, E;Hand, C
目的探讨药师的家庭药物复查是否影响老年人的再入院率。设计随机对照试验。研究对象为诺福克和萨福克郡的急性或社区医院出院后的家庭药物复查。参与者为872名80岁以上的老年人，他们在急诊入院期间被招募（任何原因）如果返回自己的家或监护人控制的住所，并在出院时每天服用两种或更多种药物。干预药剂师在出院后两周和八周内进行两次家访，以教育患者，护理人员了解他们的药物，删除过期的药物，通知全科医生的药物反应或相互作用，并通知当地药剂师，如果需要遵守援助。对照组接受常规护理，主要观察指标为6个月时急诊再入院的总人数。结果6个月时，对照组和干预组分别有178例和234例再入院（率比= 1.30，95%可信区间1.07 ~ 1.58; P = 0.009，Poisson模型）。干预组死亡49例，对照组死亡63例（风险比= 0.75，0.52 - 1.10; P = 0.14）。对照组EQ-5D评分平均下降（恶化）0.14，干预组平均下降0.13（差异= 0.01，-0.05至0.06; P = 0.84 t检验）。结论干预与住院率显著升高相关，但并未显著改善生活质量或减少死亡。需要进一步的研究来解释这一违反直觉的发现，并确定更有效的药物审查方法。
Objective To determine whether home based medication review by pharmacists affects hospital readmission rates among older people.Design Randomised controlled trial.Setting Home based medication review after discharge from acute or community hospitals in Norfolk and Suffolk.Participants 872 patients aged over 80 recruited during an emergency admission (any cause) if returning to own home or warden controlled accommodation and taking two or more drugs daily on discharge.Intervention Two home visits by a pharmacist within two weeks and eight weeks of discharge to educate patients and carers about their drugs, remove out of date drugs, inform general practitioners of drug reactions or interactions, and inform the local pharmacist if a compliance aid is needed. Control arm received usual care.Main outcome measure Total emergency readmissions to hospital at six months. Secondary outcomes included death and quality of life measured with the EQ-5D.Results By six months 178 readmissions had occurred in the control group and 234 in the intervention group (rate ratio = 1.30, 95% confidence interval 1.07 to 1.58; P = 0.009, Poisson model). 49 deaths Occurred in the intervention group compared with 63 in the control group (hazard ratio = 0.75, 0.52 to 1.10; P = 0.14). EQ-5D scores decreased (worsened) by a mean of 0.14 in the control group and 0.13 in the intervention group (difference = 0.01, -0.05 to 0.06; P = 0.84 t test).Conclusions The intervention was associated with a significantly higher rate of hospital admissions and did not significantly improve quality of life or reduce deaths. Further research is needed to explain this counterintuitive finding and to identify more effective methods of medication review.