髋部骨折急性护理出院后，出院目的地与骨质疏松症药物使用之间的关联：一项基于人群的队列研究

摘要(中文译文)

髋部骨折后，出院去向与骨质疏松症药物使用的差异相关。出院至长期护理机构或带长期护理服务的居家环境与较低的药物使用相关。在社区居住患者中，既往治疗史与亚组特异性估计值的差异相关，尽管正式交互检验未达到统计学显著性。出院去向可能影响髋部骨折后的骨质疏松症照护，但证据有限。利用韩国国民健康保险服务-老年人队列，我们识别了2005年至2017年间因新发髋部骨折接受手术治疗且年龄≥60岁的患者。将30天时的出院去向分类为无长期护理服务的居家、带长期护理服务的居家、医院或长期护理机构。主要结局为从急性照护医院出院后1年内使用任何骨质疏松症药物，定义为随访期间至少一次处方。计算发病率，并使用Cox比例风险模型估计校正风险比（aHRs），根据既往骨质疏松症药物使用进行分层分析。在12,226例患者中，1年内骨质疏松症药物使用因出院去向不同而存在显著差异。与无长期护理服务出院回家的患者相比，出院至长期护理机构（aHR，0.61；95% CI，0.50-0.76）和带长期护理服务回家（aHR，0.84；95% CI，0.73-0.97）与接受骨质疏松症药物的较低风险相关。在分层分析中，出院至长期护理机构在按既往治疗史定义的各亚组中均一致地与较低药物使用相关。在带长期护理服务出院的患者中，较低药物使用主要见于初治患者，而在既往有药物使用的患者中这一模式不太明显；然而，正式交互检验未达到统计学显著性。髋部骨折后骨质疏松症药物使用因出院去向不同而存在差异。在出院至长期护理机构的患者中观察到较低药物使用，在接受居家长期护理服务的患者中程度较轻。这些发现应谨慎解读，因为长期护理环境中的部分较低使用可能反映了在照护优先事项竞争或预期寿命有限背景下的适当临床决策。

Abstract

Post-discharge destination was associated with differences in osteoporosis medication use after hip fracture. Discharge to long-term care facilities or home with long-term care services was associated with lower medication use. Prior treatment history was associated with differences in subgroup-specific estimates among community-dwelling patients, although formal interaction testing was not statistically significant. Post-discharge destination may influence osteoporosis care after hip fracture, but evidence is limited. Using the National Health Insurance Service-Senior cohort in South Korea, we identified patients aged ≥ 60 years who underwent surgical treatment for incident hip fracture between 2005 and 2017. Post-discharge destination at 30 days was categorized as home without LTC services, home with LTC services, hospital, or LTC facility. The primary outcome was any osteoporosis medication use within 1 year after discharge from an acute-care hospital, defined as at least one prescription during follow-up. Incidence rates were calculated, and adjusted hazard ratios (aHRs) were estimated using Cox proportional hazards models, with stratified analyses according to prior osteoporosis medication use. Among 12,226 patients, osteoporosis medication use within 1 year differed significantly by post-discharge destination. Compared with patients discharged home without LTC services, those discharged to LTC facilities (aHR, 0.61; 95% CI, 0.50-0.76) and home with LTC services (aHR, 0.84; 95% CI, 0.73-0.97) were associated with a lower hazard of receiving osteoporosis medication. In stratified analyses, discharge to LTC facilities was consistently associated with lower medication use across subgroups defined by prior treatment history. Among patients discharged home with LTC services, lower medication use was observed primarily among treatment-naïve patients, whereas this pattern was less apparent among those with prior medication use; however, formal interaction testing was not statistically significant. Osteoporosis medication use after hip fracture was associated with differences according to post-discharge destination. Lower medication use was observed among patients discharged to LTC facilities and, to a lesser extent, among those receiving home-based LTC services. These findings should be interpreted with caution, as some of the lower use in LTC settings may reflect appropriate clinical decision-making in the context of competing care priorities or limited life expectancy.

如何引用

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