Analysis Of Related Factors Of Medication Discrepancy In Senile Patients With Osteoporotic Fractures During Hospital-Family Transition Period

Research Purpose:1.Through a quantitative study,the incidence of medication discrepancy in senile patients with osteoporotic fractures during the hospital-family transition period,the types and causes of medication discrepancy were investigated;2.To explore the influencing factors of medication discrepancy in elderly patients with osteoporotic fracture;3.Through qualitative study,the real experience of medication discrepancy in the hospital-family transition period of osteoporotic fracture in the elderly is deeply understood,and the influencing factors are analyzed.Research Methods:1.210 inpatients admitted to a hospital in Quanzhou city from June to December 2020,who were diagnosed as osteoporotic fracture by bone mineral density monitoring,were selected as the research subjects.By consulting medical advice and medical records,the patient was discharged from hospital using a general information questionnaire,a Family Apgar Index,Hamilton Anxiety Scale(HAS),and a Durg Regimen Unassisted Gramping Scale.Drugs),and the Eight-iteam Morisky Medication Adberence Scale(MMAS-8),baseline data were obtained.2.At 14 days after discharge,the medication status of the patients were collected by telephone follow-up and using Medication Error Tool(MDT).Patients with medication discrepancy were divided into deviation group,otherwise they were undeviation group.Descriptive statistics,t test,rank sum test,analysis of variance and binary linear regression analysis were used to evaluate the related factors.3.A total of 12 patients with older osteoporotic fractures who were admitted to the Department of Orthopedics,a hospital in Quanzhou city from March to May 2020 and were diagnosed with medication discrepancy during hospital-family period were selected as the research subjects,conducting semi-structured in-depth interviews,using Colaizzi’s phenomenological analysis method for data analysis.Research Results:1.In the quantitative study,a total of 210 patients with osteoporotic fracture,including 64 males and 136 females,with an average age of(73.14±9.49)years,an average length of hospitalization of(12.86±3.77)days,an average education of(5.91±2.87)years,an average number of prescribed DRUGS of(3.50±1.05)kinds,and an average DRUGS score of(42.33±16.71)points.2.Among the 210 patients included,136 patients(64.8%)had at least one medication discrepancy,and a total of 513 times of medication discrepancy occurred,with an average of 3.77 times per person.3.Among all anti-osteoporosis drugs,the discrepancy of calcium medication was the highest,which was 43.3%(78 cases);The incidence of medication deviation of bisphosphonates was second only to calcium,accounting for 42.5%(51 cases),while the incidence of medication discrepancy of Xianling Gubao glue and other Chinese patent medicines was the lowest,accounting for 16.1%(12cases).4.Among the types of medication discrepancy in all the drugs in the study,omissions medication accounted for the highest proportion,accounting for 96 cases(21.6%),irregular medication was second only to missing medication,accounting for 93 cases(20.6%),medication method error was the lowest,accounting for 3 cases(0.7%).5.In this study,a total of 282 patients with medication discrepancy were analyzed,In this study,some patients had two or more providential and/or iatrogenic medication deviations.Among all the causes of deviation,the patient-derived reasons accounted for the highest,56.7%;Iatrogenic reasons were the second(43.3%).Among the patient-derived causes,"neglecting the disease" accounted for the higest proportion(14.9%),followed by "worrying about drug side effects"(10.6%).Among iatrogenic causes,"omission or inaccuracy of medication education" accounted for the highest proportion,accounting for 11.3%(32 cases),followed by "unidentifiable drug name,dose and time on the discharge list" 9.9%(28 cases).6.The univariate analysis results of medication discrepancy showed that there were no significant differences in gender,age,number of combined diseases,number of prescribed drugs,marital status,type of medical insurance and fracture type(P > 0.05).There were significant differences in years of education,days of hospitalization,previous drug use history,home caregiver,living alone,Apgar score,MMAS-8 score,HAS score and Drugs score(P <0.05).Multivariate Logistic regression analysis showed that hospitalization days,years of education,self-medication ability and family function were the protective factors of medication deviation.The incidence of medication discrepancy was reduced to 0.563 times for each additional day of hospitalization.The discrepany of medication may reduced to 0.678 times with the increase of one year of education.The incidence of discrepancy was reduced by 0.761 times for each one point increase in self-medication ability score.Patients with a family function score of 0 to 3 were used as the control group,and those with a family function score of 7 to 10 had a 0.330-fold greater risk of medication discrepancy than those with a family function score of 0 to 3.7.In the qualitative study,the factors of medication discrepancy in elderly patients with osteoporotic fracture during the hospital-family transition period can be refined into three aspects:drug,psychological and family;Six themes: lack of confidence in the efficacy of drugs,misunderstanding of drug cognition,maladaptation to long-term medication habits,worry about the status and prognosis of the disease,and self-blame for the multiple pressures on their children,frustrated with family caregivers.Research Conclusion:1.Early medication discrepancies in elderly patients with osteoporotic fractures have been at a high level after discharge.Among all anti-osteoporosis drugs,the incidence of medication discrepancies for calcium is the highest,and drug skipping and regular medication are the most common types of medication discrepancies.2.Patient origin is the main reason for medication discrepancy in elderly patients with osteoporotic fracture,which is related to patients’ attitude of not paying attention to the disease.The iatrogenic reason is mainly related to omission or inaccuracy of medication education of medical staff.3.The result of qualitative study showed that education,hospitalization days,Apgar score and Drugs score were independent influencing factors of drug use discrepancy.The qualitative study found that drug,psychological and family influences were the influencing factors of medication discrepancies,and both emphasized that family function was an important influencing factor of medication discrepancies.