Abstract：
BACKGROUND: Hospitalization and discharge in older patients are critical and clinical pharmacists have shown to ameliorate risks. Our objective was to assess their benefit as part of the geriatric team regarding rehospitalizations and related outcomes after discharge focusing on general practitioners\' decision to continue or change discharge medication (GPD).
METHODS: Prospective implementation study with 6-month follow-up in an acute geriatric clinic. Patients ≥70 years with comorbidities, impairments, and a current drug therapy were consecutively assigned to three groups: control group (CG), implementation group (IG), and wash-out group (WG). CG only received medication reconciliation (MR) at admission; IG and their hospital physicians received a pharmaceutical counseling and medication management; during WG, pharmaceutical counseling except for MR was discontinued. We used a negative-binomial model to calculate rehospitalizations and days spent at home as well as a recurrent events survival model to investigate recurrent rehospitalizations.
RESULTS: One hundred thirty-two patients (mean age 82 years, 76 women [57.6%]) finished the project. In most of the models for rehospitalizations, a positive GPD led to fewer events. We also found an effect of pharmaceutical counseling on rehospitalizations and recurrent rehospitalizations in the CG versus WG but not in the CG versus IG models. 95.3% of medication recommendations by the pharmacist in the clinic setting were accepted. While the number of positive GPDs in CG was low (38%), pharmaceutical counseling directly to the GP in IG led to a higher number of positive GPDs (60%).
CONCLUSIONS: Although rehospitalizations were not directly reduced by our intervention in the CG versus IG, the pharmacist\'s acceptance rate in the hospital was very high and a positive GPD led to fewer rehospitalization in most models.
METHODS: Prospective implementation study with 6-month follow-up in an acute geriatric clinic. Patients ≥70 years with comorbidities, impairments, and a current drug therapy were consecutively assigned to three groups: control group (CG), implementation group (IG), and wash-out group (WG). CG only received medication reconciliation (MR) at admission; IG and their hospital physicians received a pharmaceutical counseling and medication management; during WG, pharmaceutical counseling except for MR was discontinued. We used a negative-binomial model to calculate rehospitalizations and days spent at home as well as a recurrent events survival model to investigate recurrent rehospitalizations.
RESULTS: One hundred thirty-two patients (mean age 82 years, 76 women [57.6%]) finished the project. In most of the models for rehospitalizations, a positive GPD led to fewer events. We also found an effect of pharmaceutical counseling on rehospitalizations and recurrent rehospitalizations in the CG versus WG but not in the CG versus IG models. 95.3% of medication recommendations by the pharmacist in the clinic setting were accepted. While the number of positive GPDs in CG was low (38%), pharmaceutical counseling directly to the GP in IG led to a higher number of positive GPDs (60%).
CONCLUSIONS: Although rehospitalizations were not directly reduced by our intervention in the CG versus IG, the pharmacist\'s acceptance rate in the hospital was very high and a positive GPD led to fewer rehospitalization in most models.
摘要：
背景：老年患者的住院和出院至关重要，临床药师已证明可以改善风险。我们的目标是评估他们作为老年团队的一部分，在出院后的再住院和相关结局方面的益处，重点是全科医生继续或改变出院药物（GPD）的决定。
方法：在急性老年诊所进行为期6个月的前瞻性实施研究。合并疾病≥70岁的患者，损伤和目前的药物治疗连续分为三组：对照组（CG），实施组(IG)和淘汰组(WG)。CG仅在入院时接受药物和解（MR）；IG及其医院医生接受了药物咨询和药物管理；在WG期间，除MR外,药物咨询已停止.我们使用负二项模型来计算再住院和在家中度过的天数，以及复发性事件生存模型来研究复发性再住院。
结果：132名患者（平均年龄82岁，76名妇女[57,6％]）完成了该项目。在大多数再住院模型中，GPD阳性导致事件减少.我们还发现了药物咨询对CG中的再住院和复发性再住院的影响。WG组，但不在CG和IG模型中。95.3％的临床药剂师的药物建议被接受。虽然CG中阳性GPD的数量较低(38%)，在IG中直接对GP进行药物咨询导致更多的阳性GPD(60%).
结论：尽管我们在CG与CG中的干预并未直接减少再住院率IG组,药剂师在医院的接受率非常高,在大多数模型中,GPD阳性导致再住院次数减少.临床试验标识符NCT03412903。
方法：在急性老年诊所进行为期6个月的前瞻性实施研究。合并疾病≥70岁的患者，损伤和目前的药物治疗连续分为三组：对照组（CG），实施组(IG)和淘汰组(WG)。CG仅在入院时接受药物和解（MR）；IG及其医院医生接受了药物咨询和药物管理；在WG期间，除MR外,药物咨询已停止.我们使用负二项模型来计算再住院和在家中度过的天数，以及复发性事件生存模型来研究复发性再住院。
结果：132名患者（平均年龄82岁，76名妇女[57,6％]）完成了该项目。在大多数再住院模型中，GPD阳性导致事件减少.我们还发现了药物咨询对CG中的再住院和复发性再住院的影响。WG组，但不在CG和IG模型中。95.3％的临床药剂师的药物建议被接受。虽然CG中阳性GPD的数量较低(38%)，在IG中直接对GP进行药物咨询导致更多的阳性GPD(60%).
结论：尽管我们在CG与CG中的干预并未直接减少再住院率IG组,药剂师在医院的接受率非常高,在大多数模型中,GPD阳性导致再住院次数减少.临床试验标识符NCT03412903。
