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Assessing patient work system factors for medication management during transition of care among older adults: an observational study.
Xiao, Yan; Hsu, Yea-Jen; Hannum, Susan M; Abebe, Ephrem; Kantsiper, Melinda E; Pena, Ivonne Marie; Wessell, Andrea M; Dy, Sydney M; Howell, Eric E; Gurses, Ayse P.
Afiliación
  • Xiao Y; College of Nursing and Health Innovation, The University of Texas at Arlington, Arlington, Texas, USA yan.xiao.phd@gmail.com.
  • Hsu YJ; Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
  • Hannum SM; Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
  • Abebe E; College of Pharmacy, Purdue University, West Lafayette, Indiana, USA.
  • Kantsiper ME; School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
  • Pena IM; School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
  • Wessell AM; Patient Safety Organization, DARTNet Institute, Charleston, South Carolina, USA.
  • Dy SM; Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
  • Howell EE; Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
  • Gurses AP; Society of Hospital Medicine, Philadelphia, Pennsylvania, USA.
BMJ Qual Saf ; 2024 Aug 23.
Article en En | MEDLINE | ID: mdl-39179376
ABSTRACT

OBJECTIVE:

To develop and evaluate measures of patient work system factors in medication management that may be modifiable for improvement during the care transition from hospital to home among older adults. DESIGN, SETTINGS AND

PARTICIPANTS:

Measures were developed and evaluated in a multisite prospective observational study of older adults (≥65 years) discharged home from medical units of two US hospitals from August 2018 to July 2019. MAIN

MEASURES:

Patient work system factors for managing medications were assessed during hospital stays using six capacity indicators, four task indicators and three medication management practice indicators. Main outcomes were assessed at participants' homes approximately a week after discharge for (1) Medication discrepancies between the medications taken at home and those listed in the medical record, and (2) Patient experiences with new medication regimens.

RESULTS:

274 of the 376 recruited participants completed home assessment (72.8%). Among capacity indicators, most older adults (80.6%) managed medications during transition without a caregiver, 41.2% expressed low self-efficacy in managing medications and 18.3% were not able to complete basic medication administration tasks. Among task indicators, more than half (57.7%) had more than 10 discharge medications and most (94.7%) had medication regimen changes. Having more than 10 discharge medications, more than two medication regimen changes and low self-efficacy in medication management increased the risk of feeling overwhelmed (OR 2.63, 95% CI 1.08 to 6.38, OR 3.16, 95% CI 1.29 to 7.74 and OR 2.56, 95% CI 1.25 to 5.26, respectively). Low transportation independence, not having a home caregiver, low medication administration skills and more than 10 discharge medications increased the risk of medication discrepancies (incidence rate ratio 1.39, 95% CI 1.01 to 1.91, incidence rate ratio 1.73, 95% CI 1.13 to 2.66, incidence rate ratio 1.99, 95% CI 1.37 to 2.89 and incidence rate ratio 1.91, 95% CI 1.24 to 2.93, respectively).

CONCLUSIONS:

Patient work system factors could be assessed before discharge with indicators for increased risk of poor patient experience and medication discrepancies during older adults' care transition from hospital to home.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: BMJ Qual Saf Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: BMJ Qual Saf Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido