关键词: 骨质疏松性骨折, 骨质疏松, 椎体骨折, 医院-家庭过渡期, 用药差异, 老年人, 影响因素分析

Abstract: Background　Generally，medication discrepancies can increase the incidence of adverse drug events，reduce the efficacy of therapy，and even lead to adverse clinical outcomes in a population.Medication discrepancies in hospital-to-home transition has become a hot topic of nursing research in North America.However，in China，many studies focus on medication errors of inpatients，few studies are about patient medication discrepancies in hospital-to-home transition.Objective　To explore the medication discrepancies and influencing factors among elderly patients with osteoporotic vertebral fracture in hospital-to-home transition，to reduce the occurrence of medication discrepancies.Methods　Elderly patients with osteoporotic vertebral fracture who were hospitalized in Spinal Surgery Department，Second Affiliated Hospital of Nantong University between June 2018 and June 2019 were enrolled.Their demographics，disease-related information，and medication data were collected via reviewing medical records on the day before discharge.A telephone follow-up was performed at 4 weeks after discharge to evaluate the occurrence and causes of medication discrepancies.Results　A total of 172 patients were included，of whom 24 were lost to follow-up，and other 148 were included in the analysis，with a final enrollment rate of 86.0%.Among these patients，80 （54.0%） had medication discrepancies（182 times），with an average of 2.28 times per person.Specifically，the major types of medication discrepancies were decreased medication frequency 〔73 times （40.1%）〕 and dose decrease 〔37 times （20.3%）〕.Forgetting to take medicine〔38 times （20.9%）〕 and undetailed medication education at discharge〔58 times （31.9%）〕 were main reasons for the medication discrepancies.Multivariate Logistic regression results showed that medical insurance types〔OR=8.606，95%CI（1.505，49.207）〕，number of fractures〔OR=0.134，95%CI（0.041，0.444）〕，family care index〔OR=2.387，95%CI（1.536，3.710）〕，and knowledge of osteoporosis〔OR=0.881，95%CI（0.797，0.973）〕 were associated with medication discrepancies among elderly patients with osteoporotic vertebral fracture in hospital-to-home transition （P<0.05）.Conclusion　In the period shortly after discharge，there was high prevalence of medication discrepancies among elderly patients with osteoporotic vertebral fracture，which was associated with medical insurance types，number of fractures，family care index，and knowledge of osteoporosis.To reduce and prevent the occurrence of medication discrepancies in hospital-to-home transition，targeted interventions should be delivered by medical workers in collaboration with the patients and their family members.

Key words: Osteoporotic fractures, Osteoporosis, Vertebral fracture, Hospital-family transition period, Medication discrepancies, Aged, Root cause analysis