Risk factors of rehospitalization in psychiatric inpatients within one year after discharge / 四川精神卫生

ObjectiveTo explore the risk factors of rehospitalization of psychiatric inpatients within one year after discharge， so as to provide references for clinical evaluation and intervention. MethodsData of patients hospitalized in the Brain Hospital Affiliated to Guangzhou Medical University from 2013 to 2017 was collected through the electronic medical record system. Survival analysis was carried out to screen the risk factors for patient readmission. Cox risk regression and survival curve analysis were also performed， meantime， multiple linear regression was used to analyze the influencing factors of the time intervals between hospital discharge and subsequent readmission within one year. ResultsAmong the 22 807 hospitalized patients， 4 602 cases （20.2%） were readmitted within one year after discharge. Age， payment methods， disease diagnosis， number of hospitalizations and hospitalization days were risk factors for readmission （P<0.01）. The readmission rates of patients aged 21~30， 31~40， 41~50 and 51~60 were 0.706， 0.631， 0.610 and 0.693 times higher than those aged ≤20， respectively. The probability of readmission of patients with twice， three times and four times of hospitalization before was 3.015， 2.824 and 4.271 times higher than those with one time of hospitalization， respectively. The readmission rate of patients hospitalized for 21~40 days and above 101 days were 1.142 and 1.181 times higher than those hospitalized for less than 20 days， respectively. Age， hospitalization days and number of hospitalizations were the influencing factors of readmission within one year after discharge， and patients with older age had longer intervals between discharge and subsequent readmission （B=0.017， P<0.01）. The time intervals between discharge and subsequent readmission were significantly longer among patients who had been hospitalized for 61~80 days than among patients who had been hospitalized for less than 20 days （B=1.226， P<0.01）. Compared with patients with one time of hospitalization， the time intervals was significantly shorter among patients with twice of hospitalization （B=-1.386， P<0.01）. ConclusionPatients aged below 20 years old and those with two， four or more times of hospitalization before have a high rate of readmission within one year after discharge， and the readmission time may be earlier among patients with two times of hospitalization， and relatively later among patients who had been hospitalized for 61~80 days.

Evaluation of Clinical Pharmacist-led Chronic Disease Management in 184 Patients with Ischemic Stroke / 中国药房

OBJECTIVE： To evaluate the effects of clinical pharmacist-led ischemic stroke management， and to provide reference for chronic disease management. METHODS： Totally 184 patients with ischemic stroke who were hospitalized in neurology department of the First Hospital of Hebei Medical University from May to August 2018 were included prospectively， and then divided into control group （92 cases） and intervention group （92 cases） by random number method. Control group did not receive clinical pharmacist intervention. In the intervention group， clinical pharmacists were the leader in the pharmaceutical care during the hospitalization， the medication education at discharge， and pharmacy follow-up after discharge. The rate of medication compliance （antiplatelet drugs， antihypertensive drugs， hypoglycemic drugs and lipid-lowering drugs） and the rate of secondary prevention and control indicators of ischemic stroke， such as blood pressure， blood glucose [glycated hemoglobin （HbA1c）] and blood lipid [low-density lipoprotein cholesterol （LDL-C）] were investigated between 2 groups at 6 months after discharge. The incidence of adverse drug reaction and the rate of rehospitalization were compared between 2 groups at 6 months after discharge. RESULTS： The number of patients in the intervention group and the control group was 84 and 82， respectively. At 6 months after discharge， the compliance rate of antiplatelet drugs in the intervention group was 96.43％， which was higher than 95.13％ of control group， but the difference was not statistically significant. The good compliance rates of antihypertensive drugs， hypoglycemic drugs and lipid-lowering drugs in the intervention group were 92.86％， 91.67％ and 77.38％， which were higher than 78.57％， 69.70％ and 60.98％ of control group， with statistical significance （P＜0.05）. The qualified rate of index of blood pressure was 89.29％ in intervention group， which was higher than 76.79％ of control group， but the difference was not statistically significant. The qualified rates of HbA1c and LDL-C in the intervention group were 80.56％ and 66.67％， which were higher than 57.58％ and 48.785 of control group， with statistical significance （P＜0.05）. The incidence of total adverse drug reactions in the intervention group was 15.48％， which was lower than 20.73％ of control group， but the difference was not statistically significant. The total rehospitalization rate in the intervention group was 7.14％， which was lower than 17.86％ of control group， the difference was statistically significant （P＜0.05）. CONCLUSIONS： The management of ischemic stroke patients with clinical pharmacists as the leading factor can improve the patient’s medication compliance， improve the qualified rate of secondary prevention and control indicators of ischemic stroke， and reduce the rate of rehospitalization.

One-Year Rehospitalization Rates of Inpatients with First-Episode Bipolar Mania Treated with Atypical Antipsychotics in Combination with Mood Stabilizers: A Preliminary Study / 대한정신약물학회지

OBJECTIVE: We compared the one-year rehospitalization rates of first-episode bipolar manic patients who were discharged while being treated with atypical antipsychotics in combination with mood stabilizers. METHODS: We monitored the rehospitalization status of the first-episode bipolar manic patients who were discharged between 1 January 2003 and 31 December 2008 while they were taking risperidone (n=34), olanzapine (n=26) or quetiapine (n=32) in combination with mood stabilizers. Rehospitalizations were tracked over a 1-year period using the Kaplan-Meier method and Cox regression model was used to analyze covariates thought to affect time to rehospitalization. RESULTS: The rehospitalization rates during the 1-year follow-up period for patients taking atypical antipsychotics plus mood stabilizers were 22.8% (n=21). There were no significant differences in rehospitalization estimated using the Kaplan-Meier formula among the patients treated with risperidone (29.4%), olanzapine (23.1%) or quetiapine (15.6%). The psychotic symptoms, previous depressive episodes, lower Global Assessment of Functioning (GAF) score at discharge and less length of first hospitalization contributed to the risk of rehospitalization. CONCLUSION: The 1-year rehospitalization rates of first-episode bipolar manic patients taking risperidone, olanzapine, or quetiapine do not differ and the psychotic symptoms and previous depressive episodes affect time to rehospitalization.

Two-Year Rehospitalization Rates of First Episode Schizophrenic Inpatients Discharged on Antipsychotic Medication : A Preliminary Study / 대한정신약물학회지

OBJECTIVE: We compared the rehospitalization rate of first-episode schizophrenic inpatients who were discharged from a university hospital while being treated with risperidone, olanzapine, quetiapine, or the conventional antipsychotic haloperidol. We also assessed other possible predictors of rehospitalization. METHODS: We monitored the rehospitalization status of all first-episode schizophrenic inpatients who were discharged from a university hospital between 1 January 2001 and 30 June 2003 while they were taking risperidone (n=16), olanzapine (n=26), quetiapine (n=9), or haloperidol (n=10). Rehospitalizations were tracked over a 2-year period using the Kaplan-Meier method. Risk factors associated with rehospitalization were examined using the Cox proportional hazards regression model. RESULTS: The rehospitalization rates estimated using the Kaplan-Meier formula for patients taking haloperidol (60.0%) did not differ significantly from the rates for patients treated with risperidone (37.5%), olanzapine (34.6%), or quetiapine (33.3%) during the 24-month follow-up period. The length of untreated illness before drug treatment predicted rehospitalization. CONCLUSION: The rehospitalization rates of first-episode schizophrenic inpatients taking risperidone, olanzapine, quetiapine, or haloperidol do not differ. However, the small number of patients who participated in this study made it difficult to establish significance.