Daniala L Weir1, Aude Motulsky2, Michal Abrahamowicz3, Todd C Lee4, Steven Morgan5, David L Buckeridge6, Robyn Tamblyn6. 1. Department of Epidemiology and Biostatistics, McGill University, Montreal, Que, Canada; Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Que, Canada. Electronic address: daniala.weir@mail.mcgill.ca. 2. Research Center, Centre hospitalier de l'Université de Montréal, Que, Canada; Department of Management, Evaluation & Health Policy, School of Public Health, Université de Montréal, Que, Canada. 3. Department of Epidemiology and Biostatistics, McGill University, Montreal, Que, Canada; Research Institute of the McGill University Health Centre, Montreal, Que, Canada. 4. Department of Epidemiology and Biostatistics, McGill University, Montreal, Que, Canada; Department of Medicine, McGill University, Montreal, Que, Canada. 5. Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, Canada. 6. Department of Epidemiology and Biostatistics, McGill University, Montreal, Que, Canada; Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Que, Canada.
Abstract
BACKGROUND: In-hospital medication reconciliation has not demonstrated reductions in adverse health outcomes, possibly because patients do not follow the changes made to their preadmission medications. Our objective was to determine the incidence of and variables associated with failure to follow newly prescribed therapies, discontinued medications, and dose changes. METHODS: A prospective cohort study of patients admitted to hospitals in Montreal, Quebec between 2014 and 2016 was conducted. Failure to follow medication changes 30 days post discharge was measured by comparing prescribed and dispensed medications. Multivariable logistic regression was used to determine characteristics associated with failure to follow changes. RESULTS: Among 2655 patients, mean age was 69.5 years (SD 14.7), and 1581 (60%) were males. There were 10,068 medication changes made at hospital discharge and 24% were not followed in the 30 days post discharge. Thirty percent of dose modifications were filled at the incorrect dose, 27% of new medications were not filled, and 12% of discontinued medications were filled. A number of factors increased the risk of failure to follow medication changes, including increasing out-of-pocket medication costs (adjusted odds ratio [aOR] 1.12; 95% confidence interval [CI], 1.07-1.18), discharge to long-term care facility (aOR 2.29; 95% CI, 1.63-3.08), and not having medications dispensed prior to admission (aOR 4.67; 95% CI, 3.75-5.90). CONCLUSION: One in 4 hospital medication changes was not followed post discharge. Health policy aimed at eliminating out-of-pocket medication costs and investigation of factors influencing failure to follow changes for those not dispensed medications prior to admission and for long-term care residents are important next steps to address this issue.
BACKGROUND: In-hospital medication reconciliation has not demonstrated reductions in adverse health outcomes, possibly because patients do not follow the changes made to their preadmission medications. Our objective was to determine the incidence of and variables associated with failure to follow newly prescribed therapies, discontinued medications, and dose changes. METHODS: A prospective cohort study of patients admitted to hospitals in Montreal, Quebec between 2014 and 2016 was conducted. Failure to follow medication changes 30 days post discharge was measured by comparing prescribed and dispensed medications. Multivariable logistic regression was used to determine characteristics associated with failure to follow changes. RESULTS: Among 2655 patients, mean age was 69.5 years (SD 14.7), and 1581 (60%) were males. There were 10,068 medication changes made at hospital discharge and 24% were not followed in the 30 days post discharge. Thirty percent of dose modifications were filled at the incorrect dose, 27% of new medications were not filled, and 12% of discontinued medications were filled. A number of factors increased the risk of failure to follow medication changes, including increasing out-of-pocket medication costs (adjusted odds ratio [aOR] 1.12; 95% confidence interval [CI], 1.07-1.18), discharge to long-term care facility (aOR 2.29; 95% CI, 1.63-3.08), and not having medications dispensed prior to admission (aOR 4.67; 95% CI, 3.75-5.90). CONCLUSION: One in 4 hospital medication changes was not followed post discharge. Health policy aimed at eliminating out-of-pocket medication costs and investigation of factors influencing failure to follow changes for those not dispensed medications prior to admission and for long-term care residents are important next steps to address this issue.
Authors: Daniala L Weir; Aude Motulsky; Michal Abrahamowicz; Todd C Lee; Steven Morgan; David L Buckeridge; Robyn Tamblyn Journal: Health Serv Res Date: 2020-05-20 Impact factor: 3.402
Authors: Bettina Habib; David Buckeridge; Melissa Bustillo; Santiago Nicolas Marquez; Manish Thakur; Thai Tran; Daniala L Weir; Robyn Tamblyn Journal: JAMIA Open Date: 2021-07-31