在老年人中,分散的门诊护理和药物治疗数量占比较高
Indrani Guzman Das1, Joanna Bryan Ringel1, Mangala Rajan1
1Weill Cornell Medicine, New York, NY.
概括
分散的医疗保健增加了老年人的药物使用. 这种效应在黑人和患有多种慢性疾病的人群中更为明显,突出了药物管理中的差异.
科学领域:
- 老年学是一门学科.
- 医疗保健服务研究 医疗服务研究
- 药理学 药理学是指药理学的学科.
背景情况:
- 门诊护理的碎片化,衡量患者护理的不连接性,是医疗保健系统日益关注的问题.
- 多药性,即使用多种药物,在老年人中普遍存在,并增加不良事件的风险.
- 了解护理碎片化和药物使用之间的相互作用对于改善老龄化人口的健康结果至关重要.
研究的目的:
- 调查美国老年人门诊护理碎片化与药物使用之间的关联.
- 为了检查这种关联如何根据慢性疾病和种族的数量而有所不同.
主要方法:
- 一项全国性的横截面研究,使用与医疗保险索赔相关的"脑卒中地理和种族差异原因" (REGARDS) 队列研究 (2003-2016) 的数据.
- 使用反向的Bice-Boxerman指数测量了护理碎片化,并通过2周的处方库存确定了药物计数.
- 采用负二项式回归,根据慢性疾病和种族对混因子和子组分析进行调整.
主要成果:
- 在4524名参与者中,40.7%的护理高度分散,59.8%使用5+类药物.
- 高水平的护理碎片化与药物计数总体增加4%有关 (P=0.03).
- 这种关联在患有4+慢性病的人群 (7%的增加,P=0.01) 和黑人参与者 (9%的增加,P=0.01) 中更为强烈.
结论:
- 分断的门诊护理独立地与老年人多药性增加有关.
- 这种关系在黑人老年人和那些管理多种慢性疾病的人群中尤为显著.
- 调查结果强调需要综合护理模式,以减轻脆弱老年人群中多药制药的风险.
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