| ObjectiveTo evaluate the incidence,Types or Causes of medication discrepancy in hospital-family transitional age in elderly patients with Type 2 Diabetes;to explore the influential factors that affect incidence of medication discrepancy in elderly patients with Type 2 Diabetes;to analyze the effects of medication discrepancy in hospital-family transitional period on Adverse drug event and blood concentration.MethodsUsing the convenience sampling method,the patients with Type 2 Diabetes who were discharged from the hospital of 3 grade in Lanzhou city from March to October 2019 were selected as the investigation subjects.A baseline survey was conducted 2 days before discharge.The questionnaire included patient demographics,Family APGAR Index(APGAR),and Self-efficacy for Appropriate Medication Use Scale(SEAMS).One week after the patient was discharged from the hospital,the patient's occurrence of medication discrepancy was assessed by telephone follow-up.The Chinese Version of the Medication Discrepancy Tool(MDT),Summary of Diabetes Self-Care Activity(SDSCA)and Morisky Medication Adherence Scale with Eight-Item(MMAS-8)were used to assess the incidence,Types or Causes of medication discrepancy,Self-management status and medication compliance of the patients with Type 2 Diabetes in one week after discharge.Through telephone follow-up and outpatient visits,assess whether the patient has an Adverse Drug Event(ADE).At the same time,the fasting blood glucose and postprandial 2h blood glucose were recorded.Binomial logistic regression analysis was run to identify the risk factors of medication discrepancy in hospital-family transitional age.The independent sample t test was used to statistically analyze the relationship between the medication discrepancy and the blood glucose.Results(1)Among 332 elderly patients Type 2 Diabetes in one week after the patient was discharged,264(79.5%)had at least 1 medication discrepancy of medication,and 543 medication discrepancies occurred,averaging 2.06 per person.(2)Among 12 types of medication discrepancy in this study,the type with the highest incidence was a decrease in the number of drug types,a total of 161 cases(29.6%),followed by an increase in the number of drug types in 85 cases(15.6%).(3)In one week after the patient was discharged,the incidence of medication discrepancy that caused by hypoglycemic agents was the highest(27.3%).Secondly,88 cases of hypertensive drugs(11.9%).Among all types of medication discrepancy,305 cases of decrease in the number of drug types,which incidence was the highest(41.2%).(4)Among 264 patients with medication discrepancy,107 cases were due to patient-derived reasons alone,66 cases were due to iatrogenic reasons,and 91 cases were due to both.The most common of patient-derived reasons was "adding or reducing drugs when the symptoms improved"(78 cases);while the common iatrogenic reasons were "incomplete/inaccurate discharge medication education,resulting in patients to take the medicine at his own discretion "(113 cases)and "inconsistency of discharged drug list and prescription "(81 cases).(5)A binary logistic regression model based on the presence or absence of medication discrepancy as a dependent variable,a total of 3 variables entered the equation.For patients with 1?5 orders of drugs as a reference,the risk of medication discrepancy for patients with 6?7,8?9,and>10 orders of drugs was 2.230 times(OR=2.230,P=0.029),3.774 times(OR=3.774,P=0.002)and 5.250 times(OR=5.250,P<0.001)than the risk of those with less than 5 orders;the likely of patients with Poor medication compliance happening medication discrepancy was 3.564 times than the patients with good medication compliance(OR=3.564,P<0.001);the higher the diabetes self-management score,the lower the incidence of medication discrepancy(OR=0.957,P=0.022).(6)In 332 elderly Type 2 Diabetes patients,41 cases(12.3%)of ADE occurred within one week after discharge.The most common ADE was hypoglycemia,and 20 cases(48.8%)were caused by hypoglycemic drugs.8 cases(8/41,19.5%)of ADE were caused by medication discrepancy,including 3 cases(3/8,37.5%)hypoglycemic events,which were caused by patients in the wrong time and way to take Hypoglycemic drugs and self-replacement of hypoglycemic drugs ordered by doctor with other drugs.In the reasons for 8 cases ADE caused by medication discrepancy,6(6/8,75.0%)involved system-medication discrepancy,2(2/8,25.0%)involved patient-medication discrepancy,and no hospitalization was due to ADE for 30 days after discharge.(7)Compared with the patients without medication discrepancy,the fasting and 2h postprandial blood glucose values of elderly Type 2 Diabetes patients with medication discrepancy were higher,and the difference was statistically significant(P<0.05).Therefore,medication discrepancy can have adverse effects on blood glucose level of patients.Conclusions(1)In the early post-hospital period,the incidence of medication discrepancy is higher in elderly patients with type 2 diabetes.Of these,the decrease in drug types and the increase in drug types are the most common type of medication discrepancy;the drugs with the highest incidence of medication discrepancy are hypoglycemic drugs.In the ADE caused by medication discrepancy,Hypoglycemia is the most common symptom.(2)The patient-originated cause account for a large proportion of all causes of hospital-home transitional medication discrepancy in elderly patients with Type 2 Diabetes,which was mainly reflected in the lack of proper medication knowledge and attitude.The reason for system-lever medication discrepancy is that the medical staff can't effectively and accurately transmit the information of the patient's medication during the transitional period.(3)Patients with more than 5 kinds of prescribed drugs,poor compliance and poor self-management of Diabetes Mellitus were at higher risk of medication discrepancy in the transition period from hospital to family.These indicators should be used as the key assessment content for early telephone follow-up after discharge.For high-risk groups with the above characteristics,the intervention of nursing follow-up should be strengthened in the early after discharge.(4)Early after discharge,the medication discrepancy induced by Patients can lead to ADE.In order to reduce the occurrence of ADE and improve the safety of medication for patients,Nurses should take the initiative to communicate and cooperate with pharmacists and doctors,do well in the guidance of discharged medicines,and promptly discover and deal with medication deviations by telephone follow-up after discharge(5)The average fasting blood glucose and the 2h postprandial blood glucose of patients with medication discrepancy were higher.Medical staff should pay more attention to the management of medication discrepancy in elderly patients with type 2 diabetes,in order to maintain the stability of blood glucose of patients,reduce the incidence of diabetic complications,and constantly improve the quality of life of patients with diabetes. |
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