Evaluating the impact of integrated ambulatory care on medication burden and pat...

연구 요약

Evaluating the impact of integrated ambulatory care on medication burden and patient-centred outcomes in older adults with multimorbidity.

International journal for quality in health care : journal of the International Society for Quality in Health Care 학술지에 발표된 이 연구는 Lo YT, Chen MH, Li CY 외 연구팀이 수행하였습니다.

이 연구는 'Evaluating the impact of integrated ambulatory care on medication burden and patient-centred outcomes in older adults with multimorbidity.'에 대한 과학적 분석을 제공합니다.

핵심 내용

BACKGROUND: Polypharmacy and fragmented care are major concerns in older adults with multimorbidity, often leading to reduced healthcare quality and adverse health outcomes, such as higher risk of medication-related problems and hospitalizations. This study aimed to evaluate the impact of Taiwan's Integrated Ambulatory Care Programme (IACP) on medication burden, functional status, and quality of life (QoL) in a real-world outpatient setting. METHODS: Participants aged ≥65 years with multimorbidity were enrolled in this single-centre prospective cohort study conducted between 1 March 2021 and 25 February 2022. The exposed group received the IACP, including comprehensive geriatric assessment, medication review, and case management; the unexposed group received usual outpatient care. The primary outcome was change in the number of chronic medications. Secondary outcomes included functional status and QoL, assessed at baseline and at 3, 6, 9, and 12 months. Generalized estimating equations were used to evaluate outcome changes over time, adjusting for baseline covariates. RESULTS: In total, 126 participants were included (exposed group, 60; unexposed group, 66). Chronic medication use significantly decreased in the exposed group (mean ± SD, 10.68 ± 4.33 to 9.08 ± 4.22; vs. unexposed group, 10.94 ± 3.71 to 11.27 ± 3.88) at 12 months. Adjusted analyses confirmed greater reductions with IACP at 3 (β = -1.52), 6 (β = -1.50), and 12 months (β = -1.87; all P < .05). No significant differences were observed in functional status or QoL outcomes between groups across follow-up. CONCLUSION: The IACP reduced medication burden in older adults with multimorbidity but did not significantly affect functional status or QoL. These findings support integrated care as a strategy to address overprescribing in real-world outpatient settings.

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