Medication changes in hospitalized older adults

描述（由申请人提供）：背景：当老年人住院时，他们出院时使用的药物方案通常与入院前使用的药物方案有很大不同。在这种情况下，药物和解错误和药物依从性问题是常见的。为了解决这些问题，很多努力都集中在改善出院时的药物和解和沟通上。然而，很少有人注意到住院期间发生的药物变化本身。这些变化往往是不适当的，并可能导致药物混淆，不依从，并在出院后数周和数月的药物不良反应。这对高血压和糖尿病等慢性病尤其重要，因为治疗这些疾病的药物在住院期间可能经常更换，出院时可能继续使用，尽管与入院原因几乎没有关系。目的：(1)了解退伍军人医院住院的老年人高血压和糖尿病用药方案改变的频率和流行病学；(2)评价这些药物变化对患者出院后一年服药坚持性和依从性的影响；(3)评估住院期间慢性药物的改变与随后的急诊室就诊和再入院之间的关系。方法：使用来自VA和Medicare的国家数据，我们将收集65岁及以上患有高血压或糖尿病并在VA医疗中心因社区获得性肺炎、尿路感染或静脉血栓栓塞而住院的退伍军人的回顾性队列。（选择这些疾病是因为它们很常见，治疗方法与治疗高血压和糖尿病的药物不同）。使用索赔数据和目标图表回顾，我们将确定500名出院时接受比入院前更积极的血压和/或血糖控制方案的患者，以及500名没有强化方案的对照组患者。我们将使用标准方法来评估出院后一年内药物的持久性和依从性。我们将使用Cox回归和混合效应广义线性模型来比较出院时接受强化治疗方案的患者与未接受强化治疗方案的患者的药物坚持性和依从性。我们将使用类似的方法来确定住院期间药物变化对随后急诊室使用和再入院的影响。

DESCRIPTION (provided by applicant): Background: When older adults are hospitalized, they are often discharged on substantially different medication regimens than the ones they were using prior to admission. In this setting, errors of medication reconciliation and problems with medication adherence are common. To address these problems, much effort has focused on improving medication reconciliation and communication at the time of discharge. However, little attention has been paid to the medication changes themselves that happen during the hospital stay. These changes are often inappropriate, and can lead to medication confusion, non-adherence, and adverse drug reactions in the weeks and months after hospital discharge. This is particularly important for chronic diseases such as hypertension and diabetes, as medicines for these conditions may often be changed during the hospital stay and perpetuated at discharge despite having little relation to the reason for admission. Aims: (1) To determine the frequency and epidemiology of changes to medication regimens for hypertension and diabetes in older adults admitted to VA hospitals; (2) To evaluate the impact of these medication changes on medication persistence and adherence in the year after discharge; and (3) To evaluate the association between changes to chronic medications during the hospital stay and subsequent emergency department visits and hospital readmissions. Methods: Using national data from VA and Medicare, we will assemble a retrospective cohort of veterans age 65 years and older who had hypertension or diabetes and were hospitalized in a VA medical center with community-acquired pneumonia, urinary tract infection, or venous thromboembolism. (These conditions were chosen because they are common and are treated with a different set of medications than those used to manage hypertension and diabetes). Using claims data and targeted chart review, we will identify 500 patients who were discharged on more aggressive regimens for blood pressure and/or glycemic control than they were receiving prior to admission, and a control group of 500 patients without intensified regimens. We will use standard methods to evaluate persistence of and adherence to medications in the year after hospital discharge. We will use Cox regression and mixed effects generalized linear models to compare medication persistence and adherence in patients who were discharged from the hospital with a more intensive medication regimen vs. patients whose medication regimens were not intensified. We will use similar methods to determine the impact of medication changes during hospitalization on subsequent emergency department use and hospital readmission.