Medication changes in hospitalized older adults

描述（由申请人提供）：背景：当老年人住院时，他们出院时的药物治疗方案通常与入院前使用的药物治疗方案大不相同。在这种情况下，药物调和的错误和药物依从性的问题是常见的。为了解决这些问题，许多努力都集中在改善出院时的药物协调和沟通。然而，很少有人注意到住院期间发生的药物变化。这些改变通常是不适当的，并可能导致用药混乱，不遵守，并在出院后的几周和几个月的药物不良反应。这对于高血压和糖尿病等慢性疾病尤其重要，因为治疗这些疾病的药物可能在住院期间经常更换，并在出院时持续使用，尽管与入院原因关系不大。目的：（1）确定VA医院收治的老年人中高血压和糖尿病药物治疗方案变更的频率和流行病学;（2）评价这些药物变更对出院后一年内药物持续性和依从性的影响;（3）评价住院期间慢性药物变更与随后急诊科就诊和再次入院之间的相关性。研究方法：使用来自VA和Medicare的国家数据，我们将收集一组年龄在65岁及以上的退伍军人，他们患有高血压或糖尿病，并因社区获得性肺炎，尿路感染或静脉血栓栓塞而在VA医疗中心住院。（选择这些条件是因为它们很常见，并且与用于管理高血压和糖尿病的药物相比，使用不同的药物进行治疗）。使用索赔数据和有针对性的图表审查，我们将确定500名患者出院时接受了比入院前更积极的血压和/或血糖控制方案，对照组500名患者没有强化方案。我们将使用标准方法评估出院后一年内药物的持续性和依从性。我们将使用考克斯回归和混合效应广义线性模型，比较出院后接受更强化药物治疗方案的患者与未接受强化药物治疗方案的患者的药物持续性和依从性。我们将使用类似的方法来确定住院期间药物变化对后续急诊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.