Barbara C Wimmer1, Elsa Dent2, J Simon Bell3, Michael D Wiese4, Ian Chapman5, Kristina Johnell6, Renuka Visvanathan7. 1. Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia barbara.wimmer@monash.edu. 2. Discipline of Medicine, University of Adelaide, Adelaide, Australia Discipline of Public Health, University of Adelaide, Adelaide, Australia. 3. Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia. 4. Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia. 5. Discipline of Medicine, University of Adelaide, Adelaide, Australia. 6. Discipline of Public Health, University of Adelaide, Adelaide, Australia Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden. 7. Discipline of Medicine, University of Adelaide, Adelaide, Australia Aged and Extended Care Services, The Queen Elizabeth Hospital and the Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, University of Adelaide, Adelaide, Australia.
Abstract
BACKGROUND: Medication-related problems and adverse drug events are leading causes of preventable hospitalizations. Few previous studies have investigated the possible association between medication regimen complexity and unplanned rehospitalization. OBJECTIVE: To investigate the association between discharge medication regimen complexity and unplanned rehospitalization over a 12-month period. METHOD: The prospective study comprised patients aged ≥70 years old consecutively admitted to a Geriatrics Evaluation and Management (GEM) unit between October 2010 and December 2011. Medication regimen complexity at discharge was calculated using the 65-item validated Medication Regimen Complexity Index (MRCI). Cox proportional-hazards regression was used to compute unadjusted and adjusted hazard ratios (HRs) with 95% CIs for factors associated with rehospitalization over a 12-month follow-up period. RESULT: Of 163 eligible patients, 99 patients had one or more unplanned hospital readmissions. When adjusting for age, sex, activities of daily living, depression, comorbidity, cognitive status, and discharge destination, MRCI (HR = 1.01; 95% CI = 0.81-1.26), number of discharge medications (HR = 1.01; 95% CI = 0.94-1.08), and polypharmacy (≥9 medications; HR = 1.12; 95% CI = 0.69-1.80) were not associated with rehospitalization. In patients discharged to nonhome settings, there was an association between rehospitalization and the number of discharge medications (HR = 1.12; 95% CI = 1.01-1.25) and polypharmacy (HR = 2.24; 95% CI = 1.02-4.94) but not between rehospitalization and MRCI (HR = 1.32; 95% CI = 0.98-1.78). CONCLUSION: Medication regimen complexity was not associated with unplanned hospital readmission in older people. However, in patients discharged to nonhome settings, the number of discharge medications and polypharmacy predicted rehospitalization. A patient's discharge destination is an important factor in unplanned medication-related readmissions.
BACKGROUND: Medication-related problems and adverse drug events are leading causes of preventable hospitalizations. Few previous studies have investigated the possible association between medication regimen complexity and unplanned rehospitalization. OBJECTIVE: To investigate the association between discharge medication regimen complexity and unplanned rehospitalization over a 12-month period. METHOD: The prospective study comprised patients aged ≥70 years old consecutively admitted to a Geriatrics Evaluation and Management (GEM) unit between October 2010 and December 2011. Medication regimen complexity at discharge was calculated using the 65-item validated Medication Regimen Complexity Index (MRCI). Cox proportional-hazards regression was used to compute unadjusted and adjusted hazard ratios (HRs) with 95% CIs for factors associated with rehospitalization over a 12-month follow-up period. RESULT: Of 163 eligible patients, 99 patients had one or more unplanned hospital readmissions. When adjusting for age, sex, activities of daily living, depression, comorbidity, cognitive status, and discharge destination, MRCI (HR = 1.01; 95% CI = 0.81-1.26), number of discharge medications (HR = 1.01; 95% CI = 0.94-1.08), and polypharmacy (≥9 medications; HR = 1.12; 95% CI = 0.69-1.80) were not associated with rehospitalization. In patients discharged to nonhome settings, there was an association between rehospitalization and the number of discharge medications (HR = 1.12; 95% CI = 1.01-1.25) and polypharmacy (HR = 2.24; 95% CI = 1.02-4.94) but not between rehospitalization and MRCI (HR = 1.32; 95% CI = 0.98-1.78). CONCLUSION: Medication regimen complexity was not associated with unplanned hospital readmission in older people. However, in patients discharged to nonhome settings, the number of discharge medications and polypharmacy predicted rehospitalization. A patient's discharge destination is an important factor in unplanned medication-related readmissions.
Authors: Barbara Caecilia Wimmer; Kristina Johnell; Johan Fastbom; Michael David Wiese; J Simon Bell Journal: Eur J Clin Pharmacol Date: 2015-06-14 Impact factor: 2.953
Authors: David Picker; Kevin Heard; Thomas C Bailey; Nathan R Martin; Gina N LaRossa; Marin H Kollef Journal: BMC Health Serv Res Date: 2015-07-23 Impact factor: 2.655
Authors: Barbara C Wimmer; J Simon Bell; Johan Fastbom; Michael D Wiese; Kristina Johnell Journal: Ann Pharmacother Date: 2015-12-17 Impact factor: 3.154
Authors: Barbara Caecilia Wimmer; J Simon Bell; Johan Fastbom; Michael David Wiese; Kristina Johnell Journal: J Gerontol A Biol Sci Med Sci Date: 2015-12-26 Impact factor: 6.053