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Post-Hospital Medication Reconciliation in Older Chinese-American Home Care Patients

TitlePost-Hospital Medication Reconciliation in Older Chinese-American Home Care Patients
Publication TypeThesis
Year of Publication2012
AuthorsHu, SHuey-Lan
Number of Pages184 p
UniversityNew York University
ISBN Number978-1-267-57300-1
KeywordsAged, 80 and Over, Chinese -- United States, Communication Barriers, Confidence Intervals, Correlation Coefficient, Correlational Studies, Descriptive Research, Educational Status, Human, Logistic Regression, Medication Errors -- Prevention and Control -- In Old Age, Medication Reconciliation, New York, Nonexperimental Studies, Nursing Home Patients, Odds Ratio, One-Way Analysis of Variance, Patient Discharge, Retrospective Design, Spearman's Rank Correlation Coefficient, United States
AbstractMedication safety is a great concern for older adults with complex medication regimens, especially during the care transitions in the U.S. healthcare system. Medication reconciliation has been suggested as a critical process to avoid medication errors, including medication discrepancies (MDs) and the use of potential inappropriate medications (PIMs). Most studies only investigate one of these medication errors, which under-present the complexity of the medication management during care transitions.
Older adults are at a high risk for medication-error-related negative consequences, including adverse drug events (ADEs), poor health outcomes, and an increase in healthcare utilization and expenses. One in every five older home care patients experienced at least one ADE within one month following hospital discharge. Older Chinese-Americans are especially at high risk for medication errors since the great majority are immigrants with low education levels and limited English proficiency. These barriers in communicating their health needs are compounded by their mistrust of Western medication. Despite their vulnerability, little is known about the prevalence and types of the common medication errors (e.g., PIMs and MDs), in older Chinese-Americans during transitions from hospital to home care.
PIMs and MDs share similar contributing factors, including number or type of medications, prescriber, hospital unit, and patient characteristics in the continuum-of-care and thus, patients who experience one medication error may be more likely to experience another one. Informed by Human Error Theory and the Continuum of Care model, the purpose of this retrospective, nonexperimental, descriptive correlational study was to investigate the prevalence of PIMs and MDs as well as the relationship between them. The visiting nurse's responses to these two errors in older Chinese-American home care patients following hospital discharge in New York City were also explored. The 2002 Beers diagnosis-independent criteria was used to identify PIMs from hospital discharge medication order. To detect MDs, the electronic hospital discharge medication order was compared to the home care admission medication order. Cramer's V and Phi coefficient, Point and Rank biserial correlation coefficient, Spearman Rho correlation coefficient, one-way analysis of variance (ANOVA) and logistic regression were used to analyze data.
Thirty-five percent of older Chinese-Americans who met the inclusion and exclusion criteria enrolled in the study (n=82). More than 80% of them had limited English capability and low education levels. About 24% of study participants had at least one PIM at hospital discharge. Nearly 67% of them had at least one MD at home care admission. Study participants who had PIM were more likely to experience MD (r=.217, p=.05). Older Chinese-Americans with more medications prescribed at hospital discharge were more likely to have at least one PIM (r=.444, p=.00) and have a higher number of PIM (r=.313, p=.004). With more medications prescribed at hospital discharge, they were more likely to have less MD (r=-.212, p=.018), but a positive association (r=.311, p=.005) was found between the number of medications documented at home care admission and MDs. Patient age and length of hospital stay was also positively associated with PIM (r=.29, p=.038 and r=.287, p=.01, respectively). Patients age 81 and older were almost 5 times (OR=4.59, 95% CI: 1.30-16.19) more likely than patients age 80 and younger to have PIMs at hospital discharge. Patients who took 8 medications and more at hospital discharge or had 6 days or longer hospital stay were about 4 times (OR=3.92, 95% CI: 1.08-14.22; OR=4.16, 95% CI: 1.09-15.88, respectively) more likely than patients who took less medication and shorter hospital stay to have PIMs at hospital discharge. Patients with 10 and higher medications identified at home care admission were almost 3 times (OR=2.57, 95% CI: 1.00-6.61) more likely than patients with less medications to have MDs.
The study findings support the practice of checking for both the inconsistency as well as the appropriateness of the medication during the medication reconciliation process. Long-term use of stimulant laxatives, overuse of ferrous sulfate, amiodarone, and cyproheptadine were the four most common PIMs identified in this sample. Missing agent is the most common type of MDs identified. These findings indicate the high risk older Chinese-Americans had for PIMs and MDs during care transitions and the importance of reconciling medications during care transitions from hospital to home.
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