Uncovering a multitude of sins: medication management in the home post acute hospitalisation among the chronically ill

Wiley - Tập 29 Số 2 - Trang 220-227 - 1999
Simon Stewart1,2, Sue Pearson2
1*S. Stewart is a recipient of a National Heart Foundation of Australia Postgraduate Medical Research Scholarship.
2Doctoral Candidate, Department of Cardiology, The Queen Elizabeth Hospital/University of Adelaide, Adelaide, SA.

Tóm tắt

AbstractBackground: Sub‐optimal use of prescribed medication is often associated with unplanned hospitalisation among the chronically ill.Aims: To examine the extent of sub‐optimal use of prescribed medication in a ‘high risk’ patient cohort recently discharged from acute hospital care.Methods: Chronically ill patients discharged from acute hospital care (n=342) were studied. At one week post discharge a home visit was performed by a nurse and a pharmacist during which medication management (including compliance and medication—related knowledge) was assessed.Results: During the majority of home visits at least one medication‐related problem was detected: approximately half of the cohort subject to a ‘reliable’ pill‐count were found to be mal‐compliant and almost all demonstrated inadequate medication‐related knowledge. Mal‐compliance was correlated with ≥ five prescribed medications (Odds ratio [OR] 2.6: p <0.002). Comparatively, lower medication‐related knowledge was correlated with age >75 years (OR 2.2: p <0.001), exacerbation of a pre‐existing chronic illness (OR 2.7: p=0.044) and six years formal education (OR 1.9: p≥0.004). Neither were modulated by extent of in‐hospital counselling. Other previously unknown problems detected during the home visit included hoarding of previously prescribed medication (35%) and reducing medication intake to minimise costs (21%).Conclusions: Management of prescribed medications among chronically ill patients recently discharged from acute hospital care is often sub‐optimal. Assessment of medication management in the home provides an invaluable opportunity to detect and address problems likely to result in poorer health outcomes.

Từ khóa


Tài liệu tham khảo

10.1161/01.CIR.95.4.1085

10.1111/j.1532-5415.1997.tb02968.x

10.1111/j.1532-5415.1997.tb00940.x

10.1016/S0735-1097(97)00214-3

10.5694/j.1326-5377.1998.tb126744.x

10.1001/archinte.158.10.1067

10.1056/NEJM198706043162301

10.1056/NEJM199108013250501

10.1016/S0002-9149(97)00820-5

Stafford RS, 1997, National patterns of angiotensin‐converting enzyme inhibitor use in congestive heart failure, Arch Intern Med, 157, 2460, 10.1001/archinte.1997.00440420092008

10.1016/S0735-1097(97)00176-9

10.1016/0140-6736(93)91951-H

10.1007/BF02598282

10.1136/bmj.310.6989.1229

Larmour I, 1991, A prospective study of hospital admissions due to drug reactions, Aust J Hosp Pharm, 21, 90

Hewitt J., 1995, Drug‐related unplanned readmissions to hospital, Aust J Hosp Pharm, 25, 400

10.1001/archinte.1990.00390160093019

10.5694/j.1326-5377.1996.tb122235.x

10.1016/0021-9681(85)90064-5

10.1111/j.1532-5415.1998.tb02535.x

Stewart S, 1995, Home medication management: A study of patient post‐hospitalisation, Aust Pharmacist, 14, 472

Anderson GF, 1985, Predicting hospital readmissions in the medicare population, Inquiry, 22, 251

10.1093/ageing/14.1.37

10.1097/00005650-198605000-00006

10.1016/0277-9536(88)90286-9

10.1136/bmj.297.6651.784

10.1136/bmj.2.6037.686

10.1007/BF00226324

10.1002/nur.4770140108

10.1046/j.1365-2648.1996.11925.x

Veggeland T, 1993, Do patients know enough about their medication? A questionnaire among cardiac patients discharged from 5 Norwegian hospitals, Tidsskrift for Den Norske Laegeforening, 113, 3013

10.1016/0277-9536(92)90206-6

10.1136/bmj.294.6568.355

10.1016/0277-9536(85)90308-9

10.1016/S0002-9343(96)00172-6

10.1093/ageing/12.4.336

10.1111/j.1532-5415.1996.tb02433.x

10.1136/pgmj.72.853.671

10.1111/j.1532-5415.1997.tb05964.x

Thông tin
Thông tin xuất bản

Wiley

Tập 29 Số 2

220-227

Thông tin tác giả