Abstract：
Whilst attention has been paid within the literature to examining potentially inappropriate prescribing (PIP) for older adults in a variety of care settings, less is known about the extent within intermediate care. Furthermore, few studies have examined the utility of clinical pharmacist involvement in this care context.
Determine the prevalence of PIP in intermediate care (IC) settings in Northern Ireland (NI), explore the utility of a novel pharmacist case management model at reducing PIP and to examine the association with subsequent healthcare utilisation.
Secondary analysis of prospective data (N = 532) collected during a medicines optimisation pharmacist case management model in three intermediate care sites in NI. Independent prescriber pharmacists delivered the intervention. Variability in Medication Appropriateness Index score change (ΔMAI) from admission to discharge was examined using multivariate linear regression analysis. Multivariate logistic and Poisson regressions were used to examine the association between ΔMAI and likelihood and numbers of unplanned hospital readmissions within 30 and 90 days of IC discharge.
PIP was highly prevalent (89.5%) at baseline with significant reductions in MAI score achieved from admission (Median = 14) to discharge (Median = 0) (Z = -18.28, p < .001). The prevalence of PIP at discharge was 7.8%. No relationship was observed between ΔMAI score and unplanned hospital readmission. Those who received at least one educational intervention were less likely to be readmitted within 30 days of IC discharge (OR = 0.15, 95% CI 0.03, 0.71, p < .001). Baseline healthcare utilisation consistently predicted healthcare utilisation post-IC discharge.
Drug-related problems persist for many older adults following acute care discharge and intermediate care may provide an ideal location for medicines optimisation interventions.
Determine the prevalence of PIP in intermediate care (IC) settings in Northern Ireland (NI), explore the utility of a novel pharmacist case management model at reducing PIP and to examine the association with subsequent healthcare utilisation.
Secondary analysis of prospective data (N = 532) collected during a medicines optimisation pharmacist case management model in three intermediate care sites in NI. Independent prescriber pharmacists delivered the intervention. Variability in Medication Appropriateness Index score change (ΔMAI) from admission to discharge was examined using multivariate linear regression analysis. Multivariate logistic and Poisson regressions were used to examine the association between ΔMAI and likelihood and numbers of unplanned hospital readmissions within 30 and 90 days of IC discharge.
PIP was highly prevalent (89.5%) at baseline with significant reductions in MAI score achieved from admission (Median = 14) to discharge (Median = 0) (Z = -18.28, p < .001). The prevalence of PIP at discharge was 7.8%. No relationship was observed between ΔMAI score and unplanned hospital readmission. Those who received at least one educational intervention were less likely to be readmitted within 30 days of IC discharge (OR = 0.15, 95% CI 0.03, 0.71, p < .001). Baseline healthcare utilisation consistently predicted healthcare utilisation post-IC discharge.
Drug-related problems persist for many older adults following acute care discharge and intermediate care may provide an ideal location for medicines optimisation interventions.
摘要：
虽然文献中已经注意到在各种护理环境中检查老年人的潜在不适当处方(PIP)，对中间护理的程度知之甚少。此外，很少有研究检查了临床药师在这种护理背景下的效用。
确定北爱尔兰（NI）的中间护理（IC）设置中PIP的患病率，探索新的药剂师病例管理模式在降低PIP方面的效用，并检查与后续医疗保健利用的关联。
在NI的三个中间护理点的药物优化药剂师病例管理模式期间收集的前瞻性数据的二次分析（N=532）。独立处方药剂师提供了干预措施。使用多元线性回归分析检查从入院到出院的用药适当性指数评分变化（ΔMAI）的变异性。多变量逻辑和泊松回归用于检查ΔMAI与IC出院后30和90天内计划外再入院的可能性和数量之间的关联。
PIP在基线时非常普遍（89.5％），从入院（中位数=14）到出院（中位数=0）的MAI评分显着降低（Z=-18.28，p<.001）。出院时PIP的患病率为7.8%。在ΔMAI评分与计划外再入院之间没有观察到关系。那些接受过至少一次教育干预的患者在IC出院后30天内再入院的可能性较小（OR=0.15，95％CI0.03，0.71，p<.001）。基线医疗保健利用率始终预测IC出院后的医疗保健利用率。
许多老年人在急性护理出院后仍然存在与药物相关的问题，中间护理可能为药物优化干预提供理想的位置。
确定北爱尔兰（NI）的中间护理（IC）设置中PIP的患病率，探索新的药剂师病例管理模式在降低PIP方面的效用，并检查与后续医疗保健利用的关联。
在NI的三个中间护理点的药物优化药剂师病例管理模式期间收集的前瞻性数据的二次分析（N=532）。独立处方药剂师提供了干预措施。使用多元线性回归分析检查从入院到出院的用药适当性指数评分变化（ΔMAI）的变异性。多变量逻辑和泊松回归用于检查ΔMAI与IC出院后30和90天内计划外再入院的可能性和数量之间的关联。
PIP在基线时非常普遍（89.5％），从入院（中位数=14）到出院（中位数=0）的MAI评分显着降低（Z=-18.28，p<.001）。出院时PIP的患病率为7.8%。在ΔMAI评分与计划外再入院之间没有观察到关系。那些接受过至少一次教育干预的患者在IC出院后30天内再入院的可能性较小（OR=0.15，95％CI0.03，0.71，p<.001）。基线医疗保健利用率始终预测IC出院后的医疗保健利用率。
许多老年人在急性护理出院后仍然存在与药物相关的问题，中间护理可能为药物优化干预提供理想的位置。
