Parents' understanding of medication at discharge and potential harm in children with medical complexity.

Autor:	Selzer A; Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Comprehensive Center for Pediatrics, Division of Pediatric Nephrology and Gastroenterology, Vienna, Austria., Eibensteiner F; Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Comprehensive Center for Pediatrics, Division of Pediatric Nephrology and Gastroenterology, Vienna, Austria., Kaltenegger L; Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Comprehensive Center for Pediatrics, Division of Pediatric Nephrology and Gastroenterology, Vienna, Austria., Hana M; Drug Information and Clinical Pharmacy, Institutional Pharmacy, University Hospital Vienna, Vienna, Austria., Laml-Wallner G; Drug Information and Clinical Pharmacy, Institutional Pharmacy, University Hospital Vienna, Vienna, Austria., Geist MB; Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Comprehensive Center for Pediatrics, Division of Pediatric Nephrology and Gastroenterology, Vienna, Austria., Mandler C; Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Comprehensive Center for Pediatrics, Division of Pediatric Nephrology and Gastroenterology, Vienna, Austria., Valent I; Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Comprehensive Center for Pediatrics, Division of Pediatric Nephrology and Gastroenterology, Vienna, Austria., Arbeiter K; Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Comprehensive Center for Pediatrics, Division of Pediatric Nephrology and Gastroenterology, Vienna, Austria., Mueller-Sacherer T; Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Comprehensive Center for Pediatrics, Division of Pediatric Nephrology and Gastroenterology, Vienna, Austria., Herle M; Drug Information and Clinical Pharmacy, Institutional Pharmacy, University Hospital Vienna, Vienna, Austria., Aufricht C; Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Comprehensive Center for Pediatrics, Division of Pediatric Nephrology and Gastroenterology, Vienna, Austria., Boehm M; Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Comprehensive Center for Pediatrics, Division of Pediatric Nephrology and Gastroenterology, Vienna, Austria michael.boehm@meduniwien.ac.at.
Jazyk:	angličtina
Zdroj:	Archives of disease in childhood [Arch Dis Child] 2024 Feb 19; Vol. 109 (3), pp. 215-221. Date of Electronic Publication: 2024 Feb 19.
DOI:	10.1136/archdischild-2022-325119
Abstrakt:	Objective: Children with medical complexity (CMC) are among the most vulnerable patient groups. This study aimed to evaluate their prevalence and risk factors for medication misunderstanding and potential harm (PH) at discharge. Design and Setting: Cross-sectional study at a tertiary care centre. Study Population: CMC admitted at Medical University of Vienna between May 2018 and January 2019. Intervention: CMC and caregivers underwent a structured interview at discharge; medication understanding and PH for adverse events were assessed by a hybrid approach. Main Outcome Measures: Medication misunderstanding rate; PH. Results: For 106 included children (median age 9.6 years), a median number of 5.0 (IQR 3.0-8.0) different medications were prescribed. 83 CMC (78.3%) demonstrated at least one misunderstanding, in 33 CMC (31.1%), potential harm was detected, 5 of them severe. Misunderstandings were associated with more medications (r=0.24, p=0.013), new prescriptions (r=0.23, p=0.019), quality of medication-related communication (r=-0.21, p=0.032), low level of education (p=0.013), low language skills (p=0.002) and migratory background (p=0.001). Relative risk of PH was 2.27 times increased (95% CI 1.23 to 4.22) with new medications, 2.14 times increased (95% CI 1.10 to 4.17) with migratory background. Conclusion: Despite continuous care at a tertiary care centre and high level of subjective satisfaction, high prevalence of medication misunderstanding with relevant risk for PH was discovered in CMC and their caregivers. This demonstrates the need of interventions to improve patient safety, with stratification of medication-related communication for high-risk groups and a restructured discharge process focusing on detection of misunderstandings ('unknown unknowns'). Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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