Steven Craig Vranian1, Kelly L Covert2, Caitlin R Mardis3, John W McGillicuddy4, Kenneth D Chavin5, Derek Dubay4, David J Taber6. 1. Division of Transplant Surgery, Medical University of South Carolina, Charleston, South Carolina. Electronic address: vranian@musc.edu. 2. College of Pharmacy, Bill Gatton College of Pharmacy, Johnson City, Tennessee. 3. Transplant Service Line, Medical University of South Carolina, Charleston, South Carolina. 4. Division of Transplant Surgery, Medical University of South Carolina, Charleston, South Carolina. 5. Department of Surgery, School of Medicine, Case Western Reserve University, Cleveland, Ohio. 6. Division of Transplant Surgery, Medical University of South Carolina, Charleston, South Carolina; Department of Pharmacy Services, Ralph H. Johnson VAMC, Charleston, South Carolina.
Abstract
BACKGROUND: There are only a limited number of studies that have sought to identify patients at high risk for medication errors and subsequent adverse clinical outcomes. This study sought to identify risk factors for increased health care resource utilization in kidney transplant recipients based on drug-related problems and self-administered surveys. METHODS: In this prospective observational study, adult kidney transplant recipients seen in the transplant clinic between September and November 2015 were surveyed for self-reported demographics, medication adherence, and health status/outlook. Subsequently, patients were assessed for associations between survey results, pharmacist-derived drug-related problems, and health resource utilization over a minimum 6-mo follow-up period. Based on univariate associations, two risk cohorts were identified and compared for health care utilization using multivariable Poisson regression. RESULTS: A total of 237 patients were included, with a mean follow-up of 8 mo. From the patient survey data, Medicaid insured or self-rated poor health status were identified as a significant risk cohort. From pharmacist assessments, those who received incorrect medication or lacked appropriate follow-up medication monitoring were identified as a significant risk cohort (pharmacy errors). The Medicaid insured or self-rated poor health status cohort experienced 43% more total health care encounters (incident rate ratios [IRR] 1.43, 1.01-2.02) and 35% more transplant clinic visits (IRR 1.35, 1.03-1.77). The pharmacy errors cohort experienced 4.2 times the rate of total health care encounters (IRR 4.17, 1.55-11.2), 4.1 times the rate of hospital readmissions (IRR 4.09, 1.58-10.6), and 2.3 times the rate of transplant clinic visits (IRR 2.31, 1.04-5.11). CONCLUSIONS: Medicaid insurance, self-rated poor health status, and errors in the medication regimen or monitoring were significant risk factors for increased health care utilization in kidney transplant recipients. Further research is warranted to validate these potential risk factors, determine the long-term impact on graft/patient survival, and assess the mutability of these risks through prospective identification and intervention.
BACKGROUND: There are only a limited number of studies that have sought to identify patients at high risk for medication errors and subsequent adverse clinical outcomes. This study sought to identify risk factors for increased health care resource utilization in kidney transplant recipients based on drug-related problems and self-administered surveys. METHODS: In this prospective observational study, adult kidney transplant recipients seen in the transplant clinic between September and November 2015 were surveyed for self-reported demographics, medication adherence, and health status/outlook. Subsequently, patients were assessed for associations between survey results, pharmacist-derived drug-related problems, and health resource utilization over a minimum 6-mo follow-up period. Based on univariate associations, two risk cohorts were identified and compared for health care utilization using multivariable Poisson regression. RESULTS: A total of 237 patients were included, with a mean follow-up of 8 mo. From the patient survey data, Medicaid insured or self-rated poor health status were identified as a significant risk cohort. From pharmacist assessments, those who received incorrect medication or lacked appropriate follow-up medication monitoring were identified as a significant risk cohort (pharmacy errors). The Medicaid insured or self-rated poor health status cohort experienced 43% more total health care encounters (incident rate ratios [IRR] 1.43, 1.01-2.02) and 35% more transplant clinic visits (IRR 1.35, 1.03-1.77). The pharmacy errors cohort experienced 4.2 times the rate of total health care encounters (IRR 4.17, 1.55-11.2), 4.1 times the rate of hospital readmissions (IRR 4.09, 1.58-10.6), and 2.3 times the rate of transplant clinic visits (IRR 2.31, 1.04-5.11). CONCLUSIONS: Medicaid insurance, self-rated poor health status, and errors in the medication regimen or monitoring were significant risk factors for increased health care utilization in kidney transplant recipients. Further research is warranted to validate these potential risk factors, determine the long-term impact on graft/patient survival, and assess the mutability of these risks through prospective identification and intervention.
Authors: David J Taber; Justin R Spivey; Victoria M Tsurutis; Nicole A Pilch; Holly B Meadows; James N Fleming; John W McGillicuddy; Charles F Bratton; Frank A Treiber; Prabhakar K Baliga; Kenneth D Chavin Journal: Clin J Am Soc Nephrol Date: 2014-04-24 Impact factor: 8.237
Authors: Jesse D Schold; Nissreen Elfadawy; Laura D Buccini; David A Goldfarb; Stuart M Flechner; Michael P Phelan; Emilio D Poggio Journal: Clin J Am Soc Nephrol Date: 2016-03-24 Impact factor: 8.237
Authors: Kelly L Covert; Caitlin R Mardis; James N Fleming; Nicole A Pilch; Holly B Meadows; Benjamin A Mardis; Prince Mohan; Maria Posadas-Salas; Titte Srinivas; David J Taber Journal: Pharmacotherapy Date: 2017-02-03 Impact factor: 4.705
Authors: David J Taber; Mulugeta Gebregziabher; Aurora Posadas; Caitlin Schaffner; Leonard E Egede; Prabhakar K Baliga Journal: J Am Coll Clin Pharm Date: 2018-06-21