Suchergebnisse

IntroductionPatients transitioning between hospital and home are at risk of experiencing adverse drug events. Hospital-based care teams require a better understanding of how therapeutic decisions and patient risk factors impact adverse health outcomes following discharge.
Objectives and ApproachThe objective was to describe medications prescribed at discharge and quantify the association between these medication classes and risk of emergency department (ED) visits within 30 days. A retrospective, population-based cohort study was conducted using linked health administrative databases of adults discharged from hospital to the community between April 2016-March 2017, in Ontario, Canada. To distinguish medications prescribed at discharge from those by community providers, we examined medications dispensed in the 30-days following hospitalization but prior to another healthcare encounter (physician visit, ED visit, or rehospitalization). Adjusted logistic regression was used to determine the association between medication classes at discharge and ED visits in 30 days post discharge.
ResultsOur study cohort included 214, 011 patients. Median age was 76 (IQR:66-82), 52% were females, 92% were discharged home and 8% were discharged to long term care. Patients were dispensed a median of 3 medications (IQR: 2-6). The most common medications included hydromorphone (16% of all patients, 71% of which represented new use), pantoprazole (15% of patients, 40% new use), furosemide (13% of patients, 34% new use), amlodipine (10% of patients, 35% new use) and oxycodone (9% of patients, 70% new use). To account for confounding by indication, we adjusted for age, sex, discharge service, discharge disposition, in hospital diagnoses and length of stay. Medications which were most highly associated with an increased risk of ED visits included antipsychotics, antiepileptics, anti-infectives, systemic corticosteroids, antihypertensives and cardiac stimulants.
Conclusion / ImplicationsCharacterizing potential medication related harm in the 30-days following hospitalization is an important first step in understanding which patients may benefit most from hospital-based medication related interventions.

Abstract
Background
Stroke service disparities experienced by individuals of African descent highlight the need to optimize services. While qualitative studies have explored participants' unique experiences and service needs, a comprehensive synthesis is lacking. To address current knowledge gaps, this review aimed to synthesize existing literature on the experiences of individuals of African descent impacted by a stroke living in high-income economy countries in terms of stroke prevention, management, and care.

Methods
A qualitative meta-synthesis incorporating a meta-study approach was conducted to obtain comprehensive and interpretive insights on the study topic. Four databases were searched to identify qualitative English-language studies published in the year 2022 or earlier on the experiences of adults of African descent who were at risk or impacted by a stroke and living in high-income economy countries. Study methods, theory, and data were analyzed using descriptive and interpretive analyses.

Results
Thirty-seven studies met our inclusion criteria, including 29 journal articles and 8 dissertations. Multiple authors reported recruitment as a key challenge in study conduct. Multiple existing theories and frameworks of health behaviours, beliefs, self-efficacy, race, and family structure informed research positionality, questions, and analysis across studies. Participant experiences were categorized as (1) engagement in stroke prevention activities and responses to stroke symptoms, (2) self-management and self-identity after stroke, and (3) stroke care experiences.

Conclusions
This study synthesizes the experiences and needs of individuals of African descent impacted by stroke. Findings can help tailor stroke interventions across the stroke care continuum, as they suggest the need for intersectional and culturally humble care approaches.