Patient Reported Receipt of Medication Instructions for Warfarin is Associated with Reduced Risk of Serious Bleeding Events

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• 作者：Joshua P. Metlay MD ; PhD (1) (2) (3) (4) (5) (6)
  Sean Hennessy PharmD ; PhD (1) (2) (3)
  A. Russell Localio JD ; PhD (1) (3)
  Xiaoyan Han MS (1) (2)
  Wei Yang MS (1) (2)
  Abigail Cohen PhD (1) (2) (3)
  Charles E. Leonard PharmD (1) (2) (3)
  Kevin Haynes PharmD (1) (3)
  Stephen E. Kimmel MD ; MSCE (1) (2) (3) (4)
  Harold I. Feldman MD ; MSCE (1) (2) (3) (4)
  Brian L. Strom MD ; MPH (1) (2) (3) (4)
  
• 关键词：anticoagulation ; patient communication ; medication safety
• 刊名：Journal of General Internal Medicine
• 出版年：2008
• 出版时间：October 2008
• 年：2008
• 卷：23
• 期：10
• 页码：1589-1594
• 全文大小：139KB
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• 作者单位：Joshua P. Metlay MD, PhD (1) (2) (3) (4) (5) (6)
  Sean Hennessy PharmD, PhD (1) (2) (3)
  A. Russell Localio JD, PhD (1) (3)
  Xiaoyan Han MS (1) (2)
  Wei Yang MS (1) (2)
  Abigail Cohen PhD (1) (2) (3)
  Charles E. Leonard PharmD (1) (2) (3)
  Kevin Haynes PharmD (1) (3)
  Stephen E. Kimmel MD, MSCE (1) (2) (3) (4)
  Harold I. Feldman MD, MSCE (1) (2) (3) (4)
  Brian L. Strom MD, MPH (1) (2) (3) (4)
  
  1. Center for Clinical Epidemiology & Biostatistics, Department of Biostatistics & Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
  2. University of Pennsylvania Program for the Reduction in Medication Errors (PRIME), Philadelphia, PA, USA
  3. Center for Education and Research on Therapeutics (CERTs), University of Pennsylvania, Philadelphia, USA
  4. Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
  5. Center for Health Equity Research and Promotion, Veterans Affairs Medical Center, Philadelphia, PA, USA
  6. 712 Blockley Hall, Philadelphia, PA, USA
  

文摘

Background Adverse drug events are an important cause of preventable hospitalizations. Objective To identify whether patient report of receipt of medication instructions and markers of complex care (multiple physicians, recent hospitalization) predict the risk of serious bleeding for older adults on warfarin. Design Prospective cohort study of older adults. Participants Subjects filled new or refill prescriptions for warfarin at the time of enrollment. Measurements Hospitalizations were identified through a state-wide registry. Discharge summaries of hospitalizations for possible warfarin related bleeding events were reviewed by trained abstractors and clinical experts. Incidence rate ratios (IRR) were estimated based on person-months of exposure using Poisson regression models. Results From March 2002 through May 2003, we enrolled a total of 2346 adults on warfarin. Over a two-year follow-up period, there were 126 hospitalizations due to warfarin-related bleeding (4.6 hospitalizations per 100 person-years of exposure). Patients who reported receiving medication instructions from either a physician or nurse plus a pharmacist had a 60% reduced rate of subsequently experiencing a serious bleeding event over the next 2?years (adjusted IRR 0.40, 95% CI 0.24-.68). Having ? physicians providing medication prescriptions over the last 3?months and filling prescriptions at >1 pharmacy over the last 3?months were independently associated with increased bleeding rates (adjusted IRRs 2.37, 95% CI 1.22-.57 and 1.61, 95% CI 0.97-.67, respectively). Conclusions The rate of warfarin-related hospitalization for bleeding is substantially lower for patients who report receiving medication instructions from a physician or nurse and a pharmacist.