title: Subtypes of potentially inappropriate medications in older Chinese-Americans during care transitions: cross sectional retrospective study.
abstract: BACKGROUND
  The number of Chinese Americans is growing and nearly 20% of older Chinese-American home care patients have at least one potentially inappropriate medications (PIMs) prescribed at hospital discharge. Further examination of PIMs during care transition is warranted, especially among older Chinese-Americans.
  
  
  OBJECTIVE
  To describe, during care transitions from hospital to home care: (i) the subtypes of PIMs, (ii) the difference of PIM prevalence prescribed at hospital discharge as compared to home care admission, (iii) the relationship between subtypes of PIMs, and (iv) issues affecting medication reconciliation among older Chinese-Americans.
  
  
  METHODS
  This cross-sectional, retrospective study was conducted in a large urban home care agency from June 2010 to July 2011. From data collected by in-home survey and chart abstraction, PIMs were identified using 2002 diagnosis-independent Beers criteria. The difference of PIM prevalence at hospital discharge and at home care admission was analyzed by Wilcoxon Signed Ranks test. The relationship between subtypes of PIMs was evaluated using Phi coefficient.
  
  
  METHODS
  82 older (age 65 years and above) Chinese-American home care patients following recent hospital discharge.
  
  
  RESULTS
  3.38% (22) and another 3.72% (28) of prescribed medications were identified as PIMs at hospital discharge and home care admission, respectively. There was no statistically significant difference in PIM prevalence identified at hospital discharge and at homecare admission (z=-1.732, p=.083). PIMs included: long-term use of stimulant laxatives and high-dosages of ferrous sulfate, and a significant relationship between these two PIMS (r=.224, p=.04). More than 80% (n=65) of study participants reported low education levels and limited English proficiency.
  
  
  CONCLUSIONS
  Subtypes of PIMs were ordered during the post-hospital transfers, indicating the necessity to review the appropriateness of medications during this transition. Guidelines such as Beer's criteria regarding appropriateness of medications should be incorporated in medication reconciliation before adding new medications to treat the older adult's health problems. The medication management process needs to be both culturally sensitive and adapted to literacy level; validating the patients' full understanding of their medications is paramount.
authors.affiliation: School of Nursing, Taipei Medical University, 250 Wu-Hsing Street, Taipei 110, Taiwan, ROC. Electronic address: sophiahu@tmu.edu.tw.
authors.forename: Sophia H
authors.initials: SH
authors.lastname: Hu
authors.affiliation: College of Nursing and Health Sciences, University of Massachusetts Boston, 100 Morrissey Boulevard, Boston, MA 02125, United States. Electronic address: janice.foust@umb.edu.
authors.forename: Janice B
authors.initials: JB
authors.lastname: Foust
authors.affiliation: New York University College of Nursing, 726 Broadway, 10th Floor, New York, NY 10003, United States. Electronic address: marie.boltz@nyu.edu.
authors.forename: Marie
authors.initials: M
authors.lastname: Boltz
authors.affiliation: Hunter-Bellevue School of Nursing, Hunter College of the City University of New York, Brookdale Campus West, Room 526, 425 East 25th Street, New York, NY 10010, United States. Electronic address: ec773@hunter.cuny.edu.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Capezuti
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001213:Asian; D003430:Cross-Sectional Studies; D005260:Female; D006699:Home Care Services; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D008297:Male; D010360:Patient Transfer; D012189:Retrospective Studies
keywords: Care transitions; Limited English proficiency; Low education levels; Medication reconciliation; Older Chinese-Americans; Potentially inappropriate medication