Predictors of Older Adult Adherence With Emergency Department Discharge Instructions.
Predictors of Older Adult Adherence With Emergency Department Discharge Instructions.
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DOI：
10.1111/acem.14105
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发表时间：
2021-03
期刊：
影响因子：
--
通讯作者：
Shah MN
中科院分区：
文献类型：
--
作者：
Benjenk I;DuGoff EH;Jacobsohn GC;Cayenne N;Jones CMC;Caprio TV;Cushman JT;Green RK;Kind AJH;Lohmeier M;Mi R;Shah MN
从急诊科（ED）出院的老年人出现不良后果的风险较高。遵守急诊科出院医嘱对于降低这些风险是必要的。本研究的目的是确定与老年急诊科门诊患者遵守急诊科出院医嘱相关的个体层面因素。
我们对一项在两个州针对从急诊科出院回家的老年人（年龄≥60岁）进行的护理过渡干预随机对照试验的对照组数据进行了二次分析。利用患者调查和病历审查的数据，我们采用多变量逻辑回归来确定与遵守书面出院医嘱相关的患者特征。结果包括患者报告的用药依从性、医生随访依从性以及对“危险信号”（健康状况恶化需要进一步医疗关注的迹象）的了解。
824名患者可能符合条件，其中699名至少在一个主要方面有数据。35%遵守用药医嘱，76%遵守随访医嘱，35%能回忆起至少一个危险信号。在多变量分析中，没有因素与不遵守用药医嘱显著相关。健康状况不佳的参与者（调整后的优势比（AOR）：0.55，95%置信区间=0.31 - 0.98）不太可能遵守随访医嘱。年龄较大（AOR随着年龄组增加呈下降趋势）、抑郁（AOR = 0.39，95%置信区间=0.17 - 0.85）或有一项或多项功能受限（AOR = 0.62，95%置信区间=0.41 - 0.94）的参与者不太可能回忆起危险信号。
从急诊科出院回家的老年人对出院医嘱的遵守率参差不齐。尽管有人认为某些亚组可能比其他组风险更高，但鉴于有机会改善从急诊科到家庭的过渡，急诊科和卫生系统应考虑为所有从急诊科出院回家的老年人提供额外的护理过渡支持。
Older adults discharged from the emergency department (ED) are at high risk for adverse outcomes. Adherence to ED discharge instructions is necessary to reduce those risks. The objective of this study is to determine the individual-level factors associated with adherence with ED discharge instructions among older adult ED outpatients. We performed a secondary analysis of data from the control group of a randomized controlled trial testing a care transitions intervention among older adults (age≥60) discharged home from the ED in two states. Taking data from patient surveys and chart reviews, we used multivariable logistic regression to identify patient characteristics associated with adherence to printed discharge instructions. Outcomes were patient-reported medication adherence, provider follow-up visit adherence, and knowledge of “red flags” (signs of worsening health requiring further medical attention). 824 patients were potentially eligible, and 699 had data in at least one pillar. 35% adhered to medication instructions and 76% adhered to follow-up instructions, 35% recalled at least one red flag. In the multivariate analysis, no factors were significantly associated with failure to adhere to medications. Participants with poor health status (adjusted odds ratio (AOR): 0.55, 95% CI=0.31-0.98) were less likely to adhere to follow-up instructions. Participants who were older (AORs trended downward as age category increased), depressed (AOR=0.39, 95% CI=0.17-0.85), or had one or more functional limitations (AOR=0.62, 95% CI=0.41-0.94) were less likely to recall red flags. Older adults discharged home from the ED have mixed rates of adherence to discharge instructions. Although it is thought that some subgroups may be higher risk than others, given the opportunity to improve ED-to-home transitions, EDs and health systems should consider providing additional care transition supports to all older adults discharged home from the ED.
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影响因子：
5.7
作者：
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通讯作者：
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