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

摘要： 背景　用药差异可增加药物不良事件发生率，降低患者治疗效果，严重时可导致不良临床结局。目前，过渡期用药的差异性研究已经成为北美地区护理的研究热点之一，国内对住院患者的服药差错研究较多，而对于医院-家庭过渡期的患者服药差异性研究相对较少。目的　对老年骨质疏松性椎体骨折患者医院-家庭过渡期用药差异进行调查，并研究其影响因素，以期减少用药差异事件的发生。方法　选取2018年6月—2019年6月入住南通大学第二附属医院脊柱外科病房的骨质疏松性椎体骨折患者。出院前1 d，对患者病历进行仔细查阅，获取其社会人口学资料、疾病相关资料、用药相关资料。出院后4周开展电话随访，使用用药差异性评估工具评估用药差异发生情况及原因。结果　入组172例患者，其中24例失访，最终纳入148例患者，有效访问率为86.0%。148例患者中，80例（54.0%）发生了182次用药差异，平均2.28次/人，其中服药次数减少〔73次（40.1%）〕和用药剂量减少〔37次（20.3%）〕为主要的用药差异类型；遗忘服药〔38次（20.9%）〕和出院药物教育不详细〔58次（31.9%）〕是主要的用药差异原因。多因素Logistic回归分析结果显示，医保类型〔OR=8.606，95%CI（1.505，49.207）〕、家庭关怀指数〔OR=2.387，95%CI（1.536，3.710）〕、骨折次数〔OR=0.134，95%CI（0.041，0.444）〕、骨质疏松知识认知〔OR=0.881，95%CI（0.797，0.973）〕是骨质疏松性椎体骨折患者发生医院-家庭过渡期用药差异的影响因素（P<0.05）。结论　出院早期，老年骨质疏松性椎体骨折患者存在较高的用药差异，医保类型、骨折次数、家庭关怀指数、骨质疏松知识认知是其发生用药差异的影响因素。医院-家庭过渡期内医务人员需协同家属和患者进行针对性干预，以减少和避免用药差异的发生。

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