Research on the condition of medication discrepancy in hospital-family transitional period in elderly patients with type 2 diabetes mellitus

doi:10.3761/j.issn.0254-1769.2021.02.011

Abstract

Abstract:

Objective To evaluate the incidence,types,causes and influential factors of medication discrepancy in hospital-family transitional period in elderly patients with Type 2 Diabetes;to explore the effects of medication discrepancy in hospital-family transitional period on blood concentration. Methods 332 patients with Type 2 Diabetes discharged from a tertiary hospital in Lanzhou city from March to October 2019 were selected. A baseline survey was conducted before discharge. A week after the discharge,Summary of Diabetes Self-Care Activity（SDSCA）,Morisky Medication Adherence Scale with Eight-Item（MMAS-8） and the Chinese Version of the Medication Discrepancy Tool（MDT） were used to evaluate the patients by telephone follow-up. The fasting blood glucose and postprandial 2 h blood glucose were recorded. Binomial logistic regression analysis was run to identify the risk factors of medication discrepancy in hospital-family transitional period. The independent sample t test was used to analyze the relationship between the medication discrepancy and the blood glucose. Results The incidence of medication discrepancy in 332 patients within a week after discharge was 79.5%. The main type of discrepancy was the decrease in the types of medication. The results of Binomial logistic regression analysis showed medication discrepancy was affected by medication compliance,quantity of prescribed drugs and the diabetes self-management score. Compared with the patients without medication discrepancy,the fasting and 2 h postprandial blood glucose values of elderly Type 2 Diabetes patients with medication discrepancy were higher,and the difference was statistically significant（P<0.05）. Conclusion In the early post-hospital period,the incidence of medication discrepancy is higher in elderly patients with Type 2 Diabetes,and medication discrepancy can have adverse effects on blood glucose level of patients. Therefore,nurses should pay more attention to the management of medication discrepancy in elderly patients with Type 2 Diabetes,actively communicate and cooperate with pharmacists and doctors,and provide guidance for patients and their families on discharge medication,so as to ensure the safety of medication and the stability of blood glucose.

Key words: Aged, Type 2 Diabetes, Medication Discrepancy, Transitions Care

摘要：

目的分析老年2型糖尿病患者在医院-家庭过渡期内用药偏差的发生率、偏差类型、偏差原因及其影响因素,并探讨医院-家庭过渡期用药偏差对血糖的影响。方法选取 2019年3月—10月在兰州市某三级甲等医院内分泌科接受住院治疗后预出院的332例老年2型糖尿病患者为调查对象,出院前收集患者的基线资料,出院后1周内,采用糖尿病自我管理活动量表、服药依从性量表及中文版用药偏差评估工具等,以电话随访的方式对患者进行调查。记录患者出院后第6~7天空腹血糖和早餐后2 h的血糖值。并通过Logistic回归确定患者用药偏差的影响因素。采用独立样本t检验分析患者用药偏差与血糖之间的关系。结果 332例患者出院后1周内用药偏差发生率为79.5%;最主要的偏差类型为“服药种类减少”;患者源性用药偏差发生原因占比较高,其中最常见的原因为“症状好转而加药或减药”;最常见的医源性用药偏差发生原因为“医护人员出院药物教育不完整或不准确,致患者自行猜测服药”。Logistic回归分析结果显示,服药依从性量表得分、医嘱药物数量及糖尿病自我管理活动量表得分是用药偏差的影响因素。与无用药偏差的患者相比,发生用药偏差的老年2型糖尿病患者的空腹血糖值和餐后2 h血糖值更高,差异有统计学意义（P<0.05）。结论老年2型糖尿病患者在出院后1周内用药偏差发生率较高,护理人员应重视老年2型糖尿病患者的用药偏差管理工作,积极地与药剂师、医生进行沟通合作,做好患者及其家属的出院药物指导,确保患者用药安全和血糖稳定。

关键词: 老年人, 2型糖尿病, 用药偏差, 过渡期护理

XUE Wenjun, NIU Xiaodan, WANG Yanhong. Research on the condition of medication discrepancy in hospital-family transitional period in elderly patients with type 2 diabetes mellitus[J]. Chinese Journal of Nursing, 2021, 56(2): 225-232.

薛文俊, 牛晓丹, 王艳红. 老年2型糖尿病患者医院-家庭过渡期用药偏差的调查研究[J]. 中华护理杂志, 2021, 56(2): 225-232.

Figures/Tables 5

References 36

[1]	Ogurtsova K, da Rocha Fernandes JD, Huang Y , et al. IDF Dia-betes Atlas:global estimates for the prevalence of diabetes for 2015 and 2040[J]. Diabetes Res Clin Pract, 2017,128:40-50.
[2]	Wang L, Gao P, Zhang M , et al. Prevalence and ethnic pattern of diabetes and prediabetes in china in 2013[J]. JAMA, 2017
	317(24):2515-2523.
[3]	贾文文, 赵慧楠, 戴付敏 , 等. 老年糖尿病患者衰弱现状及影响因素研究[J]. 中华护理杂志, 2019,54(2):188-193.
	Jia WW, Zhao HN, Dai FM , et al. The current situation and influential factors of frailty in elderly patients with diabetes[J]. Chin J Nurs, 2019,54(2):188-193.
[4]	Korey AK, Matthew JW, Michael G , et al. A fourphase approach for systematically collecting data and measuring medication discrepancies when patients transition between health care settings[J]. Res Social Adm Pharm, 2016,12(4):548-558.
[5]	Vaks Y, Bensen R, Steidtmann D , et al. Better health,less spending:redesigning the transition from pediatric to adult healthcare for youth with chronic illness[J]. Heal Care, 2016,4(1):57-68.
[6]	Peddie D, Small SS, Badke K , et al. Designing an adverse drug event reporting system to prevent unintentional reexposures to harmful drugs:study protocol for a multiple methods design[J]. JMIR Res Protoc, 2016,5(3):e169.
[7]	Naylor MD, Marcille J . Managing the transition from the hospital[J]. Manag Care, 2014,23(6):27-30.
[8]	Coleman EA, Roman SP, Hall KA , et al. Enhancing the care transitions intervention protocol to better address the needs of family caregivers[J]. J Heal Care Quality, 2015,37(1):2-11.
[9]	Setter SM, Corbett CF, Neumiller JJ . Transitional care:exploring the home healthcare nurse's role in medication management[J]. Home Healthc Now, 2012,30(1):19-26.
[10]	Setter SM, Corbett CF, Neumiller JJ , et al. Effectiveness of a pharmacist-nurse intervention on resolving medication discrepancies for patients transitioning from hospital to home health care[J]. Am J Heal-Syst Pharm, 2009,66(22):2027-2031.
[11]	Neumiller JJ, Mandal B, Weeks DL , et al. Potential adverse drug events and associated costs during transition from hospital to home[J]. Sr Care Pharm, 2019,34(6):384-392.
[12]	Smith JD, Coleman EA, Min SJ . A new tool for identifying discrepancies in postacute medications for community-dwelling older adults[J]. Am J Geriatr Pharmacother, 2004,2(2):141-148.
[13]	王秀英, 李英华, 肖锟婷 , 等. 改良版用药差异评估工具的信度与效度评价[J]. 中国药房, 2015,26(31):4460-4462.
	Wang XY, Li YH, Xiao KT , et al. Reliability and validity evaluation of modified medication discrepancy tool[J]. Chin Pharm, 2015,26(31):4460-4462.
[14]	Risser J, Jacobson TA, Kripalani S . Development and psychometric evaluation of the Self-Efficacy for Appropriate Medication Use Scale(SEAMS) in low-literacy patients with chro-nic disease[J]. J Nurs Meas, 2007,15(3):203-219.
[15]	Smilkstein G, Ashworth C, Montano D . Validity and reliability of the family APGAR as a test of family function[J]. J Fam Pract, 1982,15(2):303-311.
[16]	Morisky DE, Ang A, Krousel-Wood M . Predictive validity of a medication adherence measure forhypertensioncontrol[J]. J Clinic Hypert, 2008,10(5):348-354.
[17]	Toobert DJ, Hampson SE, Glasgow RE . The summary of diabetes self-care activities measure:results from 7 studies and a revised scale[J]. Diabet Care, 2000,23(7):943-950.
[18]	潘凌蕴 . 老年慢性肾脏病患者医院-家庭过渡期用药偏差的发生情况及相关因素研究[D]. 南京:南京大学, 2018.
	Pan LY . Study on the incidence and related factors of medication discrepancy in hospital-family transitional period in elderly patients with chronic kidney disease[D]. Nanjing:Nanjing University, 2018.
[19]	Manias E, Hughes C . Challenges of managing medications for older people at transition points of care[J]. Res Social Adm Pharm, 2015,11(3):442-447.
[20]	聂雪琼, 李英华, 李莉 , 等. 中国6省糖尿病患者糖尿病防治素养现状及影响因素研究[J]. 中国健康教育, 2014,30(1):7-10,30.
	Nie XQ, Li YH, Li L , et al. Study on diabetes related health literacy and its influencing factors among patients with diabetes in 6 provinces in China[J]. Chin J Heal Educ, 2014,30(1):7-10,30.
[21]	吕志伟 . 山东省糖尿病患者的就医行为研究[D]. 遵义:遵义医学院, 2018.
	Lü ZW . Study on the health seeking behavior of diabetic patients in Shandong province[D]. Zunyi:Zunyi Medical Univer-sity, 2018.
[22]	许晶晶 . 药师在2型糖尿病患者教育中的作用评估[D]. 成都:电子科技大学, 2019.
	Xu JJ . Evaluation on the role of pharmacists in educating patients with type 2 diabetes[D]. Chengdu:University of Electronic Scienceand Technology of China, 2019.
[23]	张雪梅, 黄培, 胡宴杰 , 等. 社区慢性病患者出院过渡期用药差异及相关因素研究[J]. 中国社区医师, 2017,33(28):23-25,27.
	Zhang XM, Huang P, Hu YJ , et al. Study on the differences and related factors of drug use in community chronic disease patients during the transition period[J]. Chin Community Dr, 2017,33(28):23-25,27.
[24]	胡宴杰, 黄培, 李湘萍 . 双向转诊模式下慢性心脑血管疾病患者出院后用药差异调查研究[J]. 中国社区医师, 2018,34(5):14-16,21.
	Hu YJ, Huang P, Li XP . Study on the difference of drug use in patients with chronic cardiovascular and cerebrovascular diseases after discharge under the two-way referral model[J]. Chin Community Dr, 2018,34(5):14-16,21.
[25]	Marcum ZA, Kisak A, Visoiu A , et al. Medication discrepancies and shared decision-making[J]. J Am Geriatr Soc, 2016,64(3):653-654.
[26]	Carla MM, Vera H, Barbara HG , et al. Medication-related pro-blems during transfer from hospital to home care:baseline data from Switzerland[J]. Int J Clin Pharm, 2018,40(6):1614-1620.
[27]	聂晓静, 程丽飞, 白荷荷 , 等. 对老年2型糖尿病患者实施药物重整的效果观察[J]. 中国临床药学杂志, 2019,28(6):430-434.
	Nie XJ, Cheng LF, Bai HH , et al. Observation on the effect of medication reconciliation implementation for patients with type 2 diabetes[J]. Chin J Clinic Pharm, 2019,28(6):430-434.
[28]	Breuker C, Abraham O, di Trapanie L,et al. Patients with diabetes are at high risk of serious medication errors at hospital:interest of clinical pharmacist intervention to improve healthcare[J]. Eur J Intern Med, 2017,38:38-45.
[29]	李英华, 王秀英, 陆悦 , 等. 冠心病患者出院后用药差异发生情况及相关因素的调查研究[J]. 中国药房, 2015,26(2):273-275.
	Li YH, Wang XY, Lu Y , et al. Investigation and study on medication discrepancies and related factors in patients with coronary heart disease[J]. China Pharm, 2015,26(2):273-275.
[30]	Coleman EA, Smith JD, Frank JC , et al. Preparing patients and caregivers to participate in care delivered across settings:the care transitions intervention[J]. J Am Geriatr Soc, 2004,52(11):1817-1825.
[31]	Satya S, Kiraat DM, Paula CB , et al. Drug therapy problems and medication discrepancies during care transitions in super-utilizers[J]. J Am Pharm Assoc, 2003,56(6):633-642.
[32]	Bernick SJ, Kane S . Insight into the widespread problem of nonadherence to therapy in ulcerative colitis patients[J]. Ex-pert Rev Clin Immunol, 2010,6(4):677-682.
[33]	刘士勇 . 基于8省区随访人群的基本公共卫生服务糖尿病管理效果评价[D]. 北京:中国疾病预防控制中心, 2018.
	Liu SY . Evaluation of diabetes management effect of basic public health services based on follow-up population in 8 pro-vinces and autonomous region[D]. Beijing:Chinese Center for Disease Control and Prevention, 2018.
[34]	陈璐鹭 . 某基层三级医院2型糖尿病患者用药现状调查及药学干预效果分析[D]. 南宁:广西中医药大学, 2017.
	Chen LL . An investigation on the medication status of patients with type 2 diabetes in a grassroots tertiary hospital and an analysis on the effect of pharmaceutical intervention[D]. Nanning:Guangxi University of Chinese Medicine, 2017.
[35]	段建芳 . 2型糖尿病患者血糖波动与血管并发症及胰岛β细胞功能的相关性研究[D]. 西安:第四军医大学, 2017.
	Duan JF . Correlation of glucose fluctuation with vascular complications and pancreatic β cell function in type 2 diabetes mellitus[D]. Xi'an: Fourth Military Medical University, 2017.
[36]	嵇加佳, 刘林, 楼青青 , 等. 2型糖尿病患者自我管理行为及血糖控制现状的研究[J]. 中华护理杂志, 2014,49(5):617-620.
	Ji JJ, Liu L, Lou QQ , et al. Self-management behaviors and glycemic control in patients with type 2 diabetes mellitus[J]. Chin J Nurs, 2014,49(5):617-620.